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
Payclass Filters:GR
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 21 93.000000 3441.0000 37.0000
Subtotal (Total Children Is Unduplicated) 37 106.000000 3774.0000 35.6038
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 14.000000 1050.0000 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 12 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 9.000000 675.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 17 40.000000 2703.0500 67.5763
-----------------------------------------------------------------------------------------------------------------------
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
-----------------------------------------------------------------------------------------------------------------------
Total 784.000000 6885.2000 8.7821
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 41
-----------------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 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
128 137.000000 5865.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 151 784.000000 6885.2000 1020.2000