CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 35 45.500000 1683.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 31 41.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 37 109.250000 4042.2500 37.0000
Subtotal (Total Children Is Unduplicated) 38 196.000000 5725.7500 29.2130
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 26.500000 1987.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 27.500000 1526.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
Subtotal (Total Children Is Unduplicated) 21 66.500000 4451.2500 66.9361
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 6.000000 300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 5.000000 50.0000 10.0000
TRAV-TRAVS-Travel by mile 25 1478.000000 657.8000 0.4451
Subtotal (Total Children Is Unduplicated) 25 1489.000000 1007.8000 0.6768
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Total 1751.500000 11184.8000 6.3858
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Number of Children (Unduplicated) With at Least One Service 38
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Center 02
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 23 357.000000 1655.2000 8.0100
50 1133.000000 2976.3900 0.0000
Other 286 261.500000 6553.2100 0.0000
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Total 359 1751.500000 11184.8000 8.0100