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
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 250 124.250000 4597.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 81 63.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 519 1755.000000 64935.0000 37.0000
Subtotal (Total Children Is Unduplicated) 717 1942.250000 69532.2500 35.7998
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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 2 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 89 85.500000 6412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 86 87.000000 4828.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 31 32.000000 2400.0000 75.0000
Subtotal (Total Children Is Unduplicated) 192 357.500000 21377.0000 59.7958
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 1.000000 10.0000 10.0000
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Total 2300.750000 90919.2500 39.5172
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Number of Children (Unduplicated) With at Least One Service 762
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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 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 1 1.000000 10.0000 10.0000
2615 2299.750000 90909.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2616 2300.750000 90919.2500 10.0000