CMS/EIP Fiscal Report Center: 05
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
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 285 154.000000 5698.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 240 222.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 716 2066.750000 76469.7500 37.0000
Subtotal (Total Children Is Unduplicated) 718 2442.750000 82167.7500 33.6374
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 66.500000 4987.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 29 34.000000 2550.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 88.000000 6600.0000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 69 197.500000 14692.7500 74.3937
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 3.750000 187.5000 50.0000
CONIF-CONIF-CONSULT, FACE TO FACE 5 6.000000 300.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 61.750000 3087.5000 50.0000
TRAV-TRAVS-Travel by mile 19 419.000000 186.4800 0.4451
Subtotal (Total Children Is Unduplicated) 41 490.500000 3761.4800 7.6687
-----------------------------------------------------------------------------------------------------------------------
Total 3130.750000 100621.9800 32.1399
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 719
-----------------------------------------------------------------------------------------------------------------------
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2389 1488.000000 61002.0000 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 0 0.000000 0.0000 0.0000
2369 1642.750000 39619.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4758 3130.750000 100621.9800 0.0000