Chapter 250: Texas Nurse Aide Background Check Requirements

Texas nurse aide background check requirements come from Chapter 250 of the Health and Safety Code, which forces every covered employer to run criminal history and registry checks before letting an applicant work directly with residents. Section 250.006 lists the convictions that disqualify a candidate: 26 categories carry a lifetime bar, and a second group creates a five-year wait measured from the date of conviction.¹ Getting the screening right matters on both sides. A facility that hires someone with a disqualifying conviction risks its license, and an applicant who misreads the bars can spend time and money chasing a job they cannot legally hold.

Who the Screening Rules Cover

Chapter 250 reaches well beyond traditional nursing homes. It covers nursing facilities, assisted living communities, intermediate care facilities for individuals with intellectual disabilities, home and community support services agencies, and adult day care centers.² If the setting provides ongoing care to elderly, disabled, or terminally ill Texans, it almost certainly falls under the chapter.

The screening requirement applies to anyone working as a nurse aide and to anyone in an unlicensed position that involves direct contact with residents. Direct contact is the operative test: if the role puts the worker in physical proximity to residents in a way that creates an opportunity for harm, the check is mandatory. The statute also treats individual employers the same way, so a family that privately hires a home caregiver has the same screening obligations as a large facility.¹

The Two State Registries You Must Check First

Before hiring, the employer has to verify the applicant against two state registries. The Nurse Aide Registry tracks aides who completed state-approved training and passed competency evaluations, and it records findings of abuse, neglect, or misappropriation of resident property. A substantiated finding prevents the aide from being hired into a covered role.¹

The Employee Misconduct Registry performs the same job for unlicensed staff who are not nurse aides, capturing findings of abuse, neglect, or exploitation. A disqualifying listing on either registry creates a legal barrier to employment in any Chapter 250 setting, and an employer who skips the search is in clear violation of state law.

What Information Goes to DPS for the Criminal History Check

Section 250.004 sets out what the employer submits to the Texas Department of Public Safety to pull a criminal history record. The required identifiers are the applicant’s complete name, race, sex, date of birth, and any known identifying numbers such as a Social Security number, driver’s license number, or state identification number.³

When DPS returns a result, the employer compares each conviction against the statutory list in Section 250.006. Not every conviction disqualifies. A minor traffic offense or a Class B misdemeanor theft, for example, would not bar employment. The employer has to match the specific offense and punishment level to the statute before making a hiring decision.³

Convictions That Permanently Bar Employment

The permanent tier is exactly that. No amount of time, rehabilitation, or expungement effort changes the result. Section 250.006 currently lists 26 categories of offenses that trigger a lifetime ban.¹ They fall into several groups:

Criminal homicide, including murder and capital murder.
Sexual offenses: sexual assault, aggravated sexual assault, continuous sexual abuse of a child or disabled individual, indecency with a child, indecent exposure, invasive visual recording, improper relationship between educator and student, and online solicitation of a minor.
Violence against vulnerable people: injury to a child, elderly individual, or disabled person; abandoning or endangering a child, elderly individual, or disabled person; aggravated assault; deadly conduct; and terroristic threats.
Kidnapping and trafficking: all offenses under Chapter 20 of the Penal Code, including kidnapping, unlawful restraint, and smuggling of persons, plus agreement to abduct from custody and sale or purchase of a child.
Robbery, aggravated robbery, and arson.
Financial exploitation: exploitation of a child, elderly individual, or disabled person; money laundering; and health care fraud.
Aiding suicide, obstruction or retaliation, false identification as a peace officer, and cruelty to animals.

Convictions from another state, federal court, or the Uniform Code of Military Justice count the same as a Texas conviction when the offense has substantially similar elements to anything on the permanent list.¹ Moving to Texas does not reset the clock.

Convictions With a Five-Year Bar

The second tier carries a five-year waiting period measured from the date of conviction, not the end of a sentence, probation, or parole. During that window, the person cannot hold any position involving direct resident contact.¹ The five-year bar covers:

Assault punishable as a Class A misdemeanor or felony.
Burglary.
Theft punishable as a felony.
Misapplication of fiduciary property punishable as a Class A misdemeanor or felony.
Fraudulent securing of document execution punishable as a Class A misdemeanor or felony.
False identification as a peace officer or misrepresentation of property.
Disorderly conduct involving the behaviors prohibited by Penal Code Section 42.01(a)(7), (8), or (9).

The line between tiers matters in practice. A felony theft conviction means the applicant can reapply after five years. A robbery conviction for the same dollar amount is a permanent bar. Administrators have to read the specific conviction, not just the broad offense category, to see which tier applies.

Fingerprint Checks and What They Cost

On top of the name-based criminal history check through DPS, many Texas care facilities require fingerprint-based checks that search both state and federal databases. When a fingerprint check is required, the background check unit sends the applicant instructions to schedule an appointment with a DPS-approved fingerprint vendor.⁴

The fingerprint check runs against four databases: the DPS database of Texas arrests, the FBI database of arrests nationwide, the DPS Texas sex offender registry, and the FBI National Sex Offender Registry.⁴ That is more thorough than a name-based check alone, which can miss records tied to aliases or prior legal names.

Under the current fee schedule, a fingerprint-based check for a paid employee costs $39.75: $15 for DPS processing, $13.25 for the FBI check, and $11.50 for the fingerprint vendor’s processing fee.⁵ Confirm who pays before scheduling. Practices vary by facility.

Can Someone Start Work Before Results Come Back?

Texas law allows a facility to bring someone on staff before the criminal history check comes back, with one firm restriction: the person cannot have any direct contact with residents until the results clear.⁶ A conditionally employed worker may complete orientation, handle administrative tasks, or shadow other staff, but cannot provide hands-on care, assist with daily living activities, or be left alone with residents.

The provision exists because results take time and staffing pressure is real, but it is not a loophole. If a conditionally employed person has direct resident contact before the check clears, the facility has violated the statute regardless of whether the results ultimately come back clean.

Annual Rechecks After Hire

Screening is not a one-time event. Texas administrative rules require facilities to search both the Nurse Aide Registry and the Employee Misconduct Registry annually for every unlicensed employee, looking for new findings of abuse, neglect, mistreatment, or misappropriation entered since the last review.⁷

Facilities also conduct ongoing criminal history checks and keep documentation of every search in the employee’s personnel file. Written information about the Employee Misconduct Registry must be provided to all unlicensed employees, including notice that a registry listing makes them ineligible for continued employment.⁷ An employee who was clean at hire can become disqualified later if a finding or conviction occurs during employment.

Disputing a Registry Finding

A nurse aide who receives written notice that a finding of abuse, neglect, or misappropriation will be entered on the Nurse Aide Registry has the right to dispute it before it becomes final. The process starts with an informal review. The aide must request it within 10 days of receiving the written notice, and during the review can present testimony in person or by phone to impartial HHSC staff.⁸

If HHSC upholds the finding, the aide can escalate to a formal hearing governed by the Administrative Procedure Act. That request has to be made within 30 days of receiving the informal review results. If the aide misses either deadline, HHSC treats the finding as final and enters it on the registry.⁸

The deadlines are unforgiving. Missing the 10-day window for informal review does not automatically end the process, because the aide can still request a formal hearing. Missing the 30-day hearing deadline waives the right entirely. Anyone who receives a notice of proposed findings should treat the response deadlines as hard cutoffs.

Out-of-State Aides Moving to Texas

A nurse aide certified in another state can apply for entry on the Texas Nurse Aide Registry through a reciprocity process, but a fresh background check is part of it. The applicant must complete a name-based criminal history check through DPS for each last name they have used, then submit a reciprocity application through the state’s TULIP online portal.⁹

The application requires uploading the criminal history results, an active nurse aide certificate from the other state, a valid government-issued photo ID, and a Social Security card. If the originating state does not assign an expiration date to the certification, the applicant also completes Form 5506-NAR. HHSC staff review the application, check the Employee Misconduct Registry, and issue the Texas certificate if everything clears.⁹

Approval from another state does not exempt an aide from Texas screening. Each state keeps its own registry and its own barring offenses, so an aide who was eligible to work elsewhere could still be disqualified under Section 250.006. Plan for the reciprocity timeline rather than assuming the out-of-state credential allows immediate work.

Federal Screening Runs Separately

Chapter 250 is not the only screening regime that touches these jobs. Facilities that participate in Medicare or Medicaid also have to screen against the Office of Inspector General’s List of Excluded Individuals and Entities, with monthly updates and identity verification by Social Security number or employer identification number.¹⁰ Federal exclusion criteria overlap with the state bars but are not identical, so full compliance with Chapter 250 does not automatically mean federal compliance.¹¹ When a facility uses an outside screening company instead of running the check directly through DPS, the Fair Credit Reporting Act adds disclosure, authorization, and adverse-action notice requirements that apply even when state law mandates the hiring denial.¹²

1
State of Texas. Texas Code Health and Safety Code 250.006 – Convictions Barring Employment
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State of Texas. Texas Code Health and Safety Code 250.001 – Definitions
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State of Texas. Texas Code Health and Safety Code 250.004 – Criminal History Record Information
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Texas Health and Human Services. Texas Administrative Code Chapter 745 Subchapter F – Background Checks
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Texas Department of Family and Protective Services. DFPS Background Checks Fees
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State of Texas. Texas Code Health and Safety Code 250.003 – Criminal History Check Required
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Cornell Law Institute. 26 Texas Administrative Code 506.36 – Criminal History and Nurse Aide Registry Verification
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Cornell Law Institute. 26 Texas Administrative Code 556.13 – Findings and Inquiries
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Texas Health and Human Services. CNA Initial Reciprocity Process
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Office of Inspector General. LEIE Quick Tips and Instructions
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Office of the Law Revision Counsel. 42 USC 1320a-7 – Exclusion of Certain Individuals and Entities From Participation in Federal Health Care Programs
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Office of the Law Revision Counsel. 15 USC 1681b – Permissible Purposes of Consumer Reports