CMS/EIP Fiscal Report Center: 10
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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 713 627.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2352 5782.000000 213878.5000 36.9904
Subtotal (Total Children Is Unduplicated) 2352 6409.000000 213878.5000 33.3716
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 37.000000 2775.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 8.500000 637.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 33.000000 1831.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 295 600.000000 45000.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 121 209.500000 15712.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 85 143.500000 10762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 231 458.500000 25446.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 141 210.000000 15750.0000 75.0000
Subtotal (Total Children Is Unduplicated) 435 1713.000000 118890.7500 69.4050
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 4.000000 200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 4.000000 40.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 8.000000 240.0000 30.0000
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Total 8130.000000 333009.2500 40.9605
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Number of Children (Unduplicated) With at Least One Service 2356
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Center 10
Flag Claims Units Chgs Paid
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R 260 166.750000 6169.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5981 4512.750000 198000.7500 0.0000
P 3 4.500000 58.5000 40.0000
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
4352 3446.000000 128780.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10596 8130.000000 333009.2500 40.0000