Effective Date
Instructions
Updated: 6/2026
Purpose
Service providers use Form 8615 to document a service event for on and off-site individualized skills and socialization. These services are provided to a person in the Home and Community-based Services (HCS) and Texas Home Living Service (TxHmL) waiver programs. The HCS or TxHmL program provider may choose to create their own tool for documenting on or off-site individualized skills and socialization, if it has all the required elements of Form 8615.
Procedure
When to Prepare
The service provider of on or off-site individualized skills and socialization must complete Form 8615 within 14 calendar days after the documented activity is provided.
Form Retention
The program provider must maintain a copy of the completed Form 8615 in the person’s record.
General Instructions
- Use Form 8615 for only one person.
- You may use Form 8615 for multiple billable service events. Each billable service event must have a begin and end time.
- Form 8615 is a Medicaid document used for Medicaid purposes. You understand it is your responsibility to record correct information, when using this form as this information may be subject to a court of law. Failure to record accurate information or to deliberately falsify documentation is strictly prohibited.
Detailed Instructions
Name of Person — Enter the person’s first and last name.
Individualized Skills and Socialization Provider Address — Enter the address of the individualized skills and socialization provider
Level of Need — Enter the person’s level of need.
Name of Individualized Skills and Socialization Provider — Enter the name of the entity.
Individualized Skills and Socialization Provider License No. — Enter the license number of the individualized skills and socialization provider.
On-Site Individualized Skills and Socialization
Date and Days of the Week — Enter the month, day, and year the billable activity happened.
Time In — Enter the time the billable activity started.
Time Out — Enter the time the billable activity ended.
Name of Service Provider — Enter the printed name of a service provider who provided at least one billable activity during the service event for on-site individualized skills and socialization.
Service Provider Signature — The service provider who entered their name as the service provider must sign the form. The service provider must complete a new Form 8615 if more than two service events occur in a calendar day.
Off-Site Individualized Skills and Socialization
Date and Days of the Week — Enter the month, day, and year the billable activity happened.
Ratio — Enter the ratio required for the person per 26 TAC Section 262.917 and Section 263.2017.
Service Provider — Enter one service provider. A service provider of off-site individualized skills and socialization assigned to people represented in a ratio must provide services only to the individuals and other people represented in the ratio.
Number of People — Enter the number of people receiving off-site individualized skills and socialization from the assigned service provider.
Time In — Enter the time the billable activity started.
Time Out — Enter the time the billable activity ended.
Name of Service Provider — Enter the name of the service provider who provided the service event for off-site individualized skills and socialization.
Service Provider Signature — The service provider who entered their name as the service provider must sign the form. If more than two service events occur in a calendar day, the service provider must complete a new Form 8615.
Initial all Areas Where you Helped the Person
Socialization, Self-Help, Adaptive Skills, Implementation Plan Skill Development and Community Integration — Initial the box and the related day that corresponds to activities the service provider gave. The services initialed must justify amount of time spent providing services. A minimum of one activity must be marked for a billable service claim to have occurred.
Name and Address of Community Locations Visited — This field is required to identify the locations for off-site individualized skills and socialization. Enter the name and address of each location where off-site individualized skills and socialization occurred.
Special or Unusual Occurrences — Use this field to document special or unusual incidents. Enter the date the billable activity occurred and the staff initials, if providing written documentation.
Initials — Enter the initials of the service provider providing billable activities to the person.
Questions
Email HHSC HCS Program Policy to ask about Form 8615 or instructions.