CMS/EIP Fiscal Report Center: 07
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 92 76.250000 2821.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 67 212.500000 18.5000 0.0871
TCM-T1017TL-TARGETED CASE MANAGEMENT 115 494.750000 18241.0000 36.8691
Subtotal (Total Children Is Unduplicated) 123 783.500000 21080.7500 26.9059
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 89.500000 4967.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 122.000000 9150.0000 75.0000
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 77 223.000000 14854.7500 66.6132
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 21 30.000000 300.0000 10.0000
TRAV-TRAVS-Travel by mile 3 34.000000 15.1400 0.4453
Subtotal (Total Children Is Unduplicated) 21 64.000000 315.1400 4.9241
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Total 1070.500000 36250.6400 33.8633
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Number of Children (Unduplicated) With at Least One Service 125
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Center 07
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 1 1.500000 55.5000 0.0000
P 464 533.750000 22335.8900 22335.8900
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
529 535.250000 13859.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 994 1070.500000 36250.6400 22335.8900