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It facilitates the accurate documentation of service hours delivered by providers across various programs, including TxHml, CLASS, PHC, DBMD, and STAR Plus. The form captures critical details such as consumer and employer information, daily time-in and time-out logs using 24-hour formatting, and narrative fields for service comments. Furthermore, it incorporates essential compliance statements regarding Medicaid fraud, hospitalization reporting, and legal certifications by both the employer and the service provider. The template also includes dedicated sections for FMSA agency processing, allowing for administrative tracking of payroll-related hours such as vacation, sick leave, holidays, and bonuses, ensuring structured record-keeping for Medicaid-funded healthcare services in Texas.",{"@graph":63,"@context":122},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/2024-cds-timesheet-evv-option-2-and-3-documentation-of-services-delivered/348612/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/2024-cds-timesheet-evv-option-2-and-3-documentation-of-services-delivered/348612.png","ImageObject",442,249,{"name":88,"@type":89},"Aurelia","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-22",true,{"@type":98,"interactionType":99,"userInteractionCount":8},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114,118],{"name":105,"@type":106,"acceptedAnswer":107},"How should I record time on this CDS timesheet?","Question",{"text":108,"@type":109},"All times must be recorded using the 24-hour clock format, where 8:00 A.M. is 08:00, 8:00 P.M. is 20:00, and 12:00 A.M. is 00:00.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What happens if I falsify the information on the timesheet?",{"text":113,"@type":109},"Falsification of the timesheet is considered Medicaid Fraud, which may result in dismissal from the program and potential criminal prosecution.",{"name":115,"@type":106,"acceptedAnswer":116},"Are providers required to report if the consumer was in a hospital?",{"text":117,"@type":109},"Yes, the employer and employee must certify that services were not provided while the consumer was in a hospital, nursing home, or other Medicaid-reimbursed healthcare facility, and must list any such dates.",{"name":119,"@type":106,"acceptedAnswer":120},"How can the completed timesheet be submitted?",{"text":121,"@type":109},"Timesheets may be submitted via email to cds@cdsintexas.com or faxed according to the appropriate pay schedule.","https://schema.org",{"og:url":78,"og:type":124,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":126,"canonical":78},"index,follow",{"doc_id":128,"site_id":56},348612,1790656147,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":88,"user_avatar":133,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":8,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":139,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":61,"update_tm":143,"read_time":4},1099514068365,"https://ap-avatar.wpscdn.com/avatar/10000253d8d9f28188e?_k=1776742907772140068","DOCUMENTATION OF SERVICES DELIVERED-CDS  \n\n| Bi-Weekly *You may email timesheets to [cds@cdsintexas.com](cds@cdsintexas.com) or reference the pay schedule for the appropriate fax number to send in your timesheet |  |  |  |\n| --- | --- | --- | --- |\n| | Consumer Name: Program Selection (Please Circle) Employer Name: TxHml CLASS PHC DBMD STAR Plus HCS STAR Kids(MDCP) STAR Kids(PCS) Service Provider Name: \u003Cbr>Type of Service (Please Circle)\u003Cbr>HAB PAS PAS/HAB RESPITE FFSS Protective Supervision LVN/RN PT/OT |  |  |\n| EVV 1722 Option 2 and 3-Timesheet-Hours Worked Documentation |  | \u003Cbr>Pay Period Number:\u003Cbr>|  |\n| DATE DAY TIME IN TIME OUT TIME IN TIME OUT TIME IN TIME OUT TOTAL TIME COMMENTS / NARRATIVE Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Total Payroll / Pay Period Hours Delivered:\u003Cbr>**USE 24 HOUR TIME: 8:00 A. M OR 20:00 FOR 8:00 P. M. Enter 12:00 AM as 00:00\u003Cbr>Was the consumer hospitalized or in an medical care facility during this pay period? Please list dates: \u003Cbr>Employer and Employee here by certify that the work hours listed above are accurate, that the services provided are in accordance with the current tasks authorized and the services were NOT provided while the consumer was in the hospital, nursing home, or the Medicaid-reimbursed healthcare facility. I understand that falsification of this time sheet is considered Medicaid Fraud, and may result in dismissal from the program and criminal prosecution.\u003Cbr>Service Provider Signature Date Employer or DR Signature Date |  |  | Service:    Hours Vacation\u003Cbr>  Hours Sick\u003Cbr>  Hours Holiday\u003Cbr>  Bonus\u003Cbr>  Other  \u003Cbr>FMSA Agency Only Date Processed:\u003Cbr>By Whom:\u003Cbr>FMSA Comments |","cbCaigcJDWzwM3Tg","https://ap.wps.com/l/cbCaigcJDWzwM3Tg","pdf",98706,"English","# Documentation of Services Delivered\n## Bi-Weekly Time Reporting\n## Program and Service Selection\n## Hours Worked Log\n## Compliance and Certification\n## Payroll Processing Sections","[{\"question\":\"How should I record time on this CDS timesheet?\",\"answer\":\"All times must be recorded using the 24-hour clock format, where 8:00 A.M. is 08:00, 8:00 P.M. is 20:00, and 12:00 A.M. is 00:00.\"},{\"question\":\"What happens if I falsify the information on the timesheet?\",\"answer\":\"Falsification of the timesheet is considered Medicaid Fraud, which may result in dismissal from the program and potential criminal prosecution.\"},{\"question\":\"Are providers required to report if the consumer was in a hospital?\",\"answer\":\"Yes, the employer and employee must certify that services were not provided while the consumer was in a hospital, nursing home, or other Medicaid-reimbursed healthcare facility, and must list any such dates.\"},{\"question\":\"How can the completed timesheet be submitted?\",\"answer\":\"Timesheets may be submitted via email to cds@cdsintexas.com or faxed according to the appropriate pay schedule.\"}]","2024 CDS Timesheet EVV Option 2 and 3 - Documentation of Services Delivered | PDF",1790075950]