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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 529 560.000000 20720.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 272 342.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 162 303.500000 11220.2500 36.9695
Subtotal (Total Children Is Unduplicated) 592 1206.250000 31940.2500 26.4790
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 14 22.250000 1112.5000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 27.500000 1526.2500 55.5000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 30 51.750000 2738.7500 52.9227
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 14.500000 725.0000 50.0000
CONIF-CONIF-CONSULT, FACE TO FACE 23 18.000000 900.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 12.000000 300.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 22 105.000000 5250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 3.000000 30.0000 10.0000
TRAV-TRAVS-Travel by mile 90 5444.000000 2423.0450 0.4451
Subtotal (Total Children Is Unduplicated) 95 5596.500000 9628.0450 1.7204
-----------------------------------------------------------------------------------------------------------------------
Total 6854.500000 44307.0450 6.4639
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 616
-----------------------------------------------------------------------------------------------------------------------
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2 10.000000 4.4600 0.0000
10 11.250000 369.7500 0.0000
Other 2578 6833.250000 43932.8350 0.0000
---------------------------------------------------------
Total 2590 6854.500000 44307.0450 0.0000