CMS/EIP Fiscal Report Center: 55
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 776 906.250000 33531.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 174 163.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 228 606.750000 22449.7500 37.0000
Subtotal (Total Children Is Unduplicated) 840 1676.500000 55981.0000 33.3916
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 4 7.000000 451.0500 64.4357
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EI Services,Class #03
CONIP-CONIP-CONSULT, PHONE 7 1.750000 43.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 19.000000 950.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11 20.750000 993.7500 47.8916
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Total 1704.250000 57425.8000 33.6956
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Number of Children (Unduplicated) With at Least One Service 843
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Center 55
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 4 2.500000 46.2500 83.2500
D 40 41.500000 1535.5000 0.0000
S 2 2.500000 92.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2764 1657.750000 55751.5500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2810 1704.250000 57425.8000 83.2500