Form 8615, On-site and Off-site Individualized Skills and Socialization Service Delivery Log, and Form 8616, In-Home Individualized Skills and Socialization Service Delivery Log, are no longer mandatory to document a service claim of on-site, off-site, or in-home individualized skills and socialization.
A program provider may develop their own service delivery logs or use an electronic health record system to document individualized skills and socialization. All elements from Form 8615 and Form 8616 must be included in any documentation developed.
For each service event the service delivery log must include the following elements:
- Individual’s name
- Name of the individualized skills and socialization provider
- Individualized skills and socialization Provider License Number
- Date of service
- Time in and time out for each service event
- Description of billable activities
- Name and signature of service provider
For off-site service delivery logs, in addition to the information above for each service event, the elements that must be documented include:
- Individual’s level of need (LON)
- Ratio or approved enhanced staff rate
- Number of individuals being served by the service provider during the service event
- Name and address of community location(s) visited during the off-site service event
- Name and signature of the service provider
For in-home service delivery logs, in addition to the information for each service event, the elements that must be documented include:
- Staff ID as assigned by the program provider
HHSC will update Form 8615 and Form 8616 to provide Spanish-language versions. Any submission of forms containing information that is not in English will need to comply with 26 TAC §263.7.
For providers who use Form 8615 and Form 8616, HHSC has provided clarification below:
Form 8616 and Form 8615 are only required to document service events for individuals in the HCS and TxHmL Programs.
In the off-site section of the form:
- “Ratio” refers to the ratio for the individual as required by 26 TAC §263.2017 (HCS) or 26 TAC §262.917 (TxHmL).
- “Staff” would equal one.
- “Individuals” refers to the total number of individuals or other persons receiving services assigned to a service provider during a service event. This does not include any identifying information. *Persons outside of the HCS and TxHmL Programs, receiving a similar service, must be included in the number of individuals for the delivery of off-site individualized skills and socialization.
Form 8615 and Form 8616 were developed to document a service event for on-site, off-site, or in-home individualized skills and socialization. Program providers may request additional information or documentation from an individualized skills and socialization provider to obtain updates on the progress or lack of progress towards an individual’s goals.
The days of the week included on Form 8615 and Form 8616 may be altered if an individual receives individualized skills and socialization on a Sunday or Saturday. The program provider must ensure that an individual does not exceed the service limit of five days per calendar week (Sunday–Saturday).
Each service event must have an exact time in and time out and all documented elements. The total amount of time providing the service each day cannot be combined into one service event for that date.
If a program provider chooses to complete Form 8615 or Form 8616 electronically, it must be in compliance with 40 TAC §49.305(j) related to a contractor using electronic records.
For questions about this alert or the service delivery logs for individualized skills and socialization, email HCSPolicy@hhs.texas.gov.