Texas Business Payroll & HR
Texas Healthcare Payroll & HR Solutions
Simplify Compliance. Strengthen Your Workforce. Support Better Patient Care.
The Texas Healthcare Landscape
Rapid Growth — and Rising Complexity
Texas has emerged as one of the fastest-growing healthcare markets in the U.S. Major systems such as Texas Medical Center, Harris Health System, Memorial Hermann, and HCA Healthcare continue to expand across Houston, Austin, and North Texas, driving employment and innovation statewide.
With a booming senior population, growing demand for long-term care, and an expanding network of clinics and specialty centers, the healthcare workforce in Texas is under constant pressure to deliver high-quality, compliant, and efficient service.
Challenges Facing Texas Healthcare Employers
The Need for Professional Payroll & HR Support
The growth of the healthcare sector brings new layers of administrative and compliance complexity. Texas providers face increasing demands related to:
- Overtime and shift management
- Multi-role and multi-location payroll
- Employee retention and turnover
- Workplace safety and OSHA compliance
- Tax reporting and new hire requirements
Affiliated HR & Payroll helps healthcare organizations navigate these challenges with systems built for healthcare’s fast pace and regulatory demands.
Starting and Operating a Healthcare Facility in Texas
Most healthcare facilities in Texas must be licensed through the Texas Department of State Health Services (DSHS).
Depending on the facility type, employers must:
- Submit applications and fees
- Pass architectural and life safety reviews
- Complete an early on-site survey
For long-term care providers, Texas maintains additional licensing and credentialing standards, all accessible through the Texas Unified Licensure Information Portal (TULIP).
Employers must also perform criminal background checks for all hires, verify employability status through NAR, MAR, and EMR registries, and report all new hires to the Texas Office of the Attorney General within 20 days.
Healthcare facilities participating in state programs must enroll through the Texas Medicaid and Healthcare Partnership (TMHP).
Payroll Management for Texas Healthcare
Handle Complex Pay Structures with Confidence
Texas healthcare payroll is rarely straightforward. Between per diem workers, shift differentials, and multiple locations, it’s easy for compliance errors to slip through.
Affiliated’s payroll platform ensures accuracy and transparency across all areas of payroll management, including:
- Complex Pay Structures: Manage shift differentials, on-call pay, and per diem staff seamlessly.
- Overtime Compliance: Apply the standard 40-hour rule or the healthcare-specific 8/80 rule for hospitals and residential care facilities.
- Employee Classification: Avoid costly misclassifications by properly applying exempt and non-exempt status.
Payroll Taxes & Reporting: Stay current on SUTA, wage reporting, and local tax variations across Texas counties.
Multi-Location & Multi-Role Challenges
Affiliated simplifies wage calculations, shift differentials, and county-based compliance, all within one integrated system designed to adapt as your workforce evolves.
Texas Wage and Hour Laws for Healthcare Workers
Overtime Rules
In Texas, which applies FLSA standards for overtime calculation, hospitals and residential care facilities are entitled to use a fixed work period (14 consecutive days) rather than the traditional 40-hour workweek. The 8 and 80 exception grants employers the right to pay workers 1.5x their regular rate for all time over eight hours in a workday or eighty hours in a 14-day work period.
The 8 and 80 overtime calculation approach is legal in Texas as long as the worker and employer have agreed in advance. Additionally, employers are entitled to use the 8 and 80 method even if other employees or workers receive overtime pay based on a traditional 40-hour system.
Payday Law and Final Paycheck Requirements
To comply with Texas final paycheck laws, employers must pay involuntarily terminated employees within six days and voluntary separations by the next payday. Final pay must include wages, commissions, and fringe benefits.
Breaks and Meal Periods
Healthcare employers in Texas are not strictly required to give workers or employees breaks during the workday. However, if breaks are granted, employers must be compliant with legal definitions of rest breaks vs. coffee breaks, and properly differentiate between compensable hours worked and non-compensable meal breaks.
Nurses, Part 541 Exemptions
Occasionally, nurses will qualify for the learned professional employee exemption. This is especially true among registered nurses who are paid on a salary basis of $684 per week or more. However, this exemption rarely applies to licensed practical nurses and other healthcare employees who do not possess a specialized advanced academic degree as a prerequisite for hiring. These employees remain eligible for overtime pay.
Home Health Care Industry & Minimum Wage
In some cases, employers are not required to pay minimum wage or overtime premium pay to workers who provide home health care service. This usually applies to workers providing “companionship services,” as well as certain certified nurse aides, home health care aides, and registered nurses whose services meet specific criteria.
Nursing Care Facilities & Noncompliance Risks
Employers who operate nursing care facilities must pay all non-exempt employees according to FLSA & Texas state minimum wage & overtime laws. It’s essential to avoid common compliance violations like uncompensated time for hours worked before or after a shift, during a meal period, or during a staff meeting or training session.
Texas Healthcare and Youth Employment
Texas (in compliance with FLSA guidelines) places a number of restrictions on hours worked and job types performed, especially among 14- and 15-year-old workers/employees. Similarly, all workers under the age of 18 are protected by a number of hazard-related restrictions (called hazard orders) to ensure their health and well-being in the workplace.
The Health Care Industry, Rounding Errors, and Hours Worked
Healthcare employers in Texas should also avoid common payroll mistakes like consistently rounding down an employee’s tracked hours to the nearest quarter hour (an FLSA violation). Similarly, remember that the vast majority of lectures, training programs, and meetings qualify as “working time” unless they meet a number of criteria, including voluntary attendance.
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Staying Compliant: Texas Payroll and Labor Laws Healthcare Facilities Can’t Afford to Overlook
Labor Law Compliance in Texas Healthcare
OSHA Standards, Safety Codes, and Poster Requirements
Texas follows federal OSHA standards and additional state-level regulations like Texas Labor Code Chapter 411 and Texas Health & Safety Code Chapter 331 to protect healthcare workers.
Affiliated provides ongoing compliance support, including:
- OSHA and workplace safety program guidance
- Labor law poster kits (English and Spanish)
- Real-time updates for federal and state requirements
Labor Law Poster Requirements
The size of your workforce and whether you are a public or private employer can impact the specific number (and type) of labor law posters your business is required to post – typically required in both English and Spanish. In general, most employers in Texas are required to display the following posters:
- Texas Payday Law poster
- Unemployment Compensation Act poster
- Reporting Workplace Violence notice
- Equal Employment Opportunity poster
- Workers’ Compensation posters (including Employer’s Notice of Ombudsman Program and Notice Regarding Communicable Diseases for most healthcare employers who offer workers’ compensation)
- Earned Income Tax Credit (EITC) Notice
- All federally required posters, in compliance with the Department of Labor’s guidelines
Affiliated helps your business avoid sizable penalties by providing fully laminated, attorney-approved posters that cover federal and state requirements and keep you compliant in real time.
Workers’ Compensation in Texas Healthcare
Texas healthcare employers are not legally required to carry workers’ compensation unless contracted by a government agency, but opting out carries significant risk.
Additionally, you are still required to inform employees about whether coverage is available and provide annual notice regarding your decision to the Texas Division of Workers’ Compensation (DWC).
If you do offer workers’ compensation, you are required to cover medical care, lost wages, family benefits, and burial services in the event of an employee’s workplace injury. Workers’ compensation regulations are governed by Labor Code Chapter 411 of the Texas Workers’ Compensation Act.
Required Employer and Employee Forms
In Texas, healthcare employers need to stay mindful of state-specific forms that must be submitted or retained to ensure legal compliance. This includes all of the following:
- New Hire Reporting – required within 20 days of hiring each individual employee and can be completed online
- Payday Notice
- Notice of Workers’ Compensation Coverage (whether offered by your organization or not)
- Healthcare-Specific Documentation regarding credentials, immunizations, and more
- Federal Compliance forms, including W-4, I-9, FMLA-related documentation, DOL Notice Regarding Health Insurance Marketplace, FCRA-compliant Consent for Background Checks
HR demands as a healthcare provider in Texas can be daunting, but with employee self-service tools, unemployment claims support, performance review systems, and compliance monitoring, Affiliated simplifies the process to improve employee retention and productivity for your business.
Whether managing a hospital, urgent care center, or long-term care facility, payroll challenges in Houston’s healthcare industry mirror the environment itself: fast-paced, compliance-driven, and constantly changing.
FAQs from Texas Healthcare Employers
How is overtime calculated for nurses and healthcare staff in Texas?
Texas follows federal (FLSA) guidelines regarding overtime calculations, which allows healthcare facilities to use the 8/80 rule (overtime after 8 hours in a day or 80 hours in a 14-day period) if an agreement is made in advance with each employee. Otherwise, they may use a standard 40-hour workweek method for calculating overtime pay.
Can I deduct the cost of uniforms or equipment from an employee’s paycheck?
Yes. In Texas, this is permitted, but only if you acquire written authorization from the employee and the deduction does not bring the employee’s pay below minimum wage.
What are the rules for final paychecks when healthcare employees resign or are terminated?
When an employee is involuntarily terminated, pay is due within six calendar days. If the employee quits, their final pay is due on the next regular payday.
Are meal and rest breaks required in Texas healthcare facilities?
Although Texas does not mandate rest or meal breaks, employers may willingly offer breaks. When they do, federal law requires compensation for employees who are not fully relieved of duty. Healthcare employers in Texas typically adopt internal policies regarding breaks, or abide by union agreements.
What posters are healthcare employers required to display in Texas?
In Texas, healthcare employers must display a number of federal and state labor law posters, including OSHA, FMLA (when applicable) and other posters mandated by the Texas Workforce Commission (TWC).
Let’s Talk About Your Texas Healthcare Organization
Schedule a consultation today to discover how Affiliated can help you simplify compliance, strengthen your workforce, and improve operational efficiency.
