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
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
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 713 627.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 835 2052.750000 75951.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1301 2679.750000 75951.7500 28.3428
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 43.000000 3225.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 19.500000 1462.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 37.500000 2081.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 11.500000 862.5000 75.0000
Subtotal (Total Children Is Unduplicated) 32 117.000000 8043.7500 68.7500
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 4.000000 40.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 4.000000 40.0000 10.0000
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Total 2800.750000 84035.5000 30.0046
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Number of Children (Unduplicated) With at Least One Service 1315
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Center 10
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 2 4.000000 40.0000 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
4051 2796.750000 83995.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4053 2800.750000 84035.5000 40.0000