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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 250 124.250000 4597.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 81 63.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1315 4709.000000 174233.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1323 4896.250000 178830.2500 36.5239
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 87 148.000000 7400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 226 217.000000 16275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 221 220.500000 12237.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 89 89.500000 6712.5000 75.0000
Subtotal (Total Children Is Unduplicated) 362 693.000000 43819.2500 63.2312
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 2.000000 60.0000 30.0000
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Total 5591.250000 222709.5000 39.8318
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Number of Children (Unduplicated) With at Least One Service 1337
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Center 57
Flag Claims Units Chgs Paid
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R 6 6.750000 249.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3322 3231.500000 128801.2500 0.0000
P 1 1.500000 55.5000 55.5000
D 8 7.750000 343.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 15 18.500000 1023.5000 0.0000
T 1 1.000000 10.0000 10.0000
2638 2324.250000 92226.2500 50.0000
Other 0 0.000000 0.0000 0.0000
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Total 5991 5591.250000 222709.5000 115.5000