CMS/EIP Fiscal Report Center: 57
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 16 9.000000 333.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7 4.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 61 236.750000 8759.7500 37.0000
Subtotal (Total Children Is Unduplicated) 61 249.750000 9092.7500 36.4074
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 27.500000 2062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 38.500000 2136.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 26.000000 1950.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 41 96.000000 6401.3500 66.6807
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 13.000000 130.0000 10.0000
TRAV-TRAVS-Travel by mile 5 625.000000 278.1500 0.4450
Subtotal (Total Children Is Unduplicated) 7 638.000000 408.1500 0.6397
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Total 983.750000 15902.2500 16.1649
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Number of Children (Unduplicated) With at Least One Service 62
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Center 57
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 170 177.750000 7624.0000 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 23 647.000000 1020.2000 1020.2000
142 159.000000 7258.0500 1395.0500
Other 0 0.000000 0.0000 0.0000
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Total 335 983.750000 15902.2500 2415.2500