TX HHS Form 8615. On-site and Off-site Individualized Skills and Socialization Service Delivery Log

Form 8615 is an official service documentation form used in Texas for Home and Community-based Services (HCS) and Texas Home Living (TxHmL) programs. It serves as a detailed delivery log for Individualized Skills and Socialization services provided both on-site and off-site. The form is designed to document when, where, and how services were delivered, who provided them, and which specific skill areas were addressed for each individual.

This form plays a key role in program compliance, service verification, and billing support. Proper completion helps demonstrate that services were delivered according to the individual’s plan of care and state program requirements.

Purpose of the Form

The primary purpose of Form 8615 is to create a clear, auditable record of Individualized Skills and Socialization services. It allows providers to track attendance, service duration, staffing ratios for off-site activities, and the types of skills supported during each service day.

This form is required to support service claims, internal monitoring, and reviews conducted by Texas Health and Human Services Commission (HHSC).

Who Must Complete Form 8615

Form 8615 must be completed by providers delivering Individualized Skills and Socialization services under the HCS or TxHmL programs. Typically, the form is filled out by direct service staff, with oversight from the provider agency.

The individual receiving services does not complete the form, but their identifying information must be accurately recorded.

When This Form Is Required

This form must be used whenever Individualized Skills and Socialization services are provided, whether on-site at a facility or off-site in the community. It is not optional when these services are billed or reviewed.

The form is not required for services outside the scope of Individualized Skills and Socialization or for programs not governed by HCS or TxHmL requirements.

Section-by-Section Explanation

Individual and Provider Information

This section identifies the individual receiving services, the provider organization, the provider license number, level of need, and the location where services took place. Accuracy here is critical, as mismatched names or license numbers are a common cause of audit issues.

On-Site Service Delivery Log

For each weekday, staff must record time in, time out, and the name of the service provider. This section documents services delivered at a provider-controlled location.

Off-Site Service Delivery Log

This section records services delivered in the community. In addition to time tracking, it requires documentation of staff-to-individual ratios, which are closely reviewed during compliance audits.

Skill Areas Assisted

Staff must initial the specific skill areas addressed, such as communication, socialization, self-help skills, adaptive skills, and implementation plan goals. This demonstrates that services align with the individual’s approved plan.

Community Integration Details

For off-site services, staff must describe community locations visited, transportation provided, and any special events or notable occurrences. These details help validate that services were truly community-based.

Comments and Staff Initials

This final section allows staff to add clarifying notes and confirm service delivery with initials and dates.

Common Mistakes to Avoid

• Missing or incomplete time-in and time-out entries
• Failing to record staff names or initials
• Not documenting staff-to-individual ratios for off-site services
• Checking skill areas that were not actually addressed
• Leaving community locations or comments too vague

Legal and Program Requirements

Form 8615 is governed by Texas HHSC rules for HCS and TxHmL programs. Providers are required to maintain accurate service delivery records to demonstrate compliance with waiver program standards.

Improper or incomplete documentation may result in denied claims, recoupment of funds, or corrective action plans.

Practical Tips for Completing the Form

• Complete entries on the same day services are delivered
• Use consistent staff names and initials across all records
• Double-check ratios for off-site activities
• Be specific when describing community locations and activities
• Review the form weekly for completeness before filing

Real-Life Use Examples

• A provider documents daily on-site socialization and self-help skill training for an individual attending a day program.
• Staff record off-site community integration activities, including transportation and volunteer skill development.
• An agency uses completed forms to respond to an HHSC compliance review.

Documents Commonly Kept With This Form

• Individual Plan of Care or Implementation Plan
• Staff schedules and credential records
• Transportation logs
• Billing and service authorization records

Frequently Asked Questions

Is Form 8615 required for every service day?

Yes. The form should be completed for each day Individualized Skills and Socialization services are provided.

Can one form cover multiple individuals?

No. A separate form must be completed for each individual receiving services.

Do off-site services require additional documentation?

Yes. Staff-to-individual ratios, locations visited, and transportation details must be recorded.

Who reviews this form?

Provider supervisors and HHSC reviewers may examine the form during audits or monitoring visits.

How long should completed forms be retained?

Retention periods follow HHSC recordkeeping requirements and provider policies.

Micro-FAQ

• Purpose: To document delivery of Individualized Skills and Socialization services.
• Who files: HCS and TxHmL service providers.
• When used: Each day services are delivered.
• Attachments: Typically kept with plans of care and billing records.
• Reviewed by: Provider agencies and Texas HHSC.

Related Forms and Records

• HCS and TxHmL Service Authorization forms
• Individual Plan of Care documentation
• Transportation and community activity logs

Form Details

Form Name: On-Site and Off-Site Individualized Skills and Socialization Service Delivery Log

Form Number: 8615

Programs: Home and Community-based Services (HCS), Texas Home Living (TxHmL)

Issued By: Texas Health and Human Services Commission (HHSC)

Revision Date: February 2023