TX HHS Form 8605. Documentation of Completion of Purchase

Form 8605 is an official Texas Health and Human Services document used to confirm that a purchase or modification funded through certain Medicaid waiver programs has been completed and reviewed. It serves as formal documentation that an individual received the approved item or service, that it meets identified needs, and that required inspections or training have taken place.

Purpose of Form 8605

The primary purpose of Form 8605 is to document the completion of a purchase such as adaptive aids, medical supplies, minor home modifications, or an emergency response system. The form is used within specific Texas waiver programs to ensure accountability, compliance, and individual satisfaction with the provided goods or services.

Programs Covered by This Form

• Community Living Assistance and Support Services (CLASS)
• Medically Dependent Children Program (MDCP)
• Deaf Blind with Multiple Disabilities (DBMD) Waiver
• Community First Choice (CFC)
• Emergency Response System (ERS) under CFC

When Form 8605 Is Required

This form must be completed after the delivery or installation of an approved item or service. It is required to close out the authorization process and to confirm that public funds were used appropriately.

When the Form Is Mandatory

• After purchasing adaptive aids or medical supplies
• After completing a minor home modification
• After installing or activating a CFC Emergency Response System

When the Form Is Not Required

• For services that do not involve a completed purchase
• For preliminary assessments or authorizations
• When no waiver-funded item has been delivered

Who Completes and Signs the Form

Form 8605 is typically completed by the service provider, with required input from the individual receiving services. Certain sections may also involve inspectors or qualified professionals, depending on the type of purchase.

• Service providers document delivery, costs, and compliance
• Individuals confirm satisfaction and training received
• Inspectors certify compliance with accessibility standards when applicable

Explanation of Key Sections

General Purchase Information

This section identifies the individual, service provider, waiver program, and type of purchase. Accurate addresses, vendor numbers, and completion dates are essential to avoid delays or rejection.

Type of Purchase

The form distinguishes between adaptive aids, medical supplies, minor home modifications, and CFC emergency response systems. Only one category should be selected per entry.

Section I – Individual Satisfaction

This section documents whether the individual is satisfied with the item or service and whether adequate training was provided. If dissatisfaction exists, a clear explanation and recommended resolution must be recorded.

Section II – Service Provider Determination

The service provider confirms whether the item meets the documented needs of the individual. If it does not, the provider must explain the issue and outline corrective actions.

Section III – Minor Home Modification Inspection

For home modifications, this section confirms compliance with Texas Accessibility Standards. An inspector documents whether the work meets required specifications and notes any deficiencies and resolution plans.

Common Mistakes to Avoid

• Leaving satisfaction or training checkboxes incomplete
• Missing dates or inconsistent completion dates
• Failing to document reasons for dissatisfaction
• Omitting inspection details for minor home modifications
• Using the form for services not covered by the listed waiver programs

Practical Tips for Completing Form 8605

• Verify the correct waiver program before starting the form
• Ensure all costs match the submitted invoice
• Document explanations clearly when issues arise
• Attach additional pages if more space is needed
• Double-check dates and signatures before submission

Real-Life Use Examples

• A child enrolled in MDCP receives a wheelchair ramp, and Form 8605 documents installation and accessibility compliance
• An adult in the CLASS program receives adaptive bathroom equipment and confirms satisfaction and training
• A CFC participant has an emergency response system installed and uses the form to document activation and training

Documents Commonly Attached

• Vendor invoices
• Inspection reports for home modifications
• Additional qualification or certification documents
• Written explanations for unresolved issues

Frequently Asked Questions

Who is responsible for submitting Form 8605?

The service provider is generally responsible, with input and confirmation from the individual receiving services.

Is Form 8605 required for every purchase?

It is required only for waiver-funded purchases covered by the listed programs.

What happens if the individual is not satisfied?

The issue must be documented along with a recommended plan for resolution.

Can additional pages be attached?

Yes, attachments may be used if more space is needed for explanations or qualifications.

Is an inspection always required?

Inspections are required only for minor home modifications subject to accessibility standards.

How long should records be kept?

Records should be retained according to program and provider recordkeeping requirements.

Micro-FAQ

• Purpose: To document completion and compliance of waiver-funded purchases
• Who files: Service providers with individual confirmation
• Programs: CLASS, MDCP, DBMD, CFC, ERS
• Attachments: Invoices and inspection records
• Standards: Texas Accessibility Standards

Related Forms

• Waiver service authorization forms
• Adaptive aid assessment documentation
• Minor home modification request forms
• CFC Emergency Response System enrollment forms

Form Details

• Form Name: Documentation of Completion of Purchase
• Form Number: 8605
• Programs: Texas Medicaid Waiver Programs
• Region: Texas
• Revision Date: May 2015 (E)