CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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 676 795.750000 29442.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 337 461.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 164 333.000000 12321.0000 37.0000
Subtotal (Total Children Is Unduplicated) 723 1590.250000 41763.7500 26.2624
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 16.000000 800.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 30.000000 1665.0000 55.5000
Subtotal (Total Children Is Unduplicated) 27 48.000000 2576.0000 53.6667
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 11.750000 587.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 13 10.750000 537.5000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.000000 73.3200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 25 203.750000 10187.5000 50.0000
TRAV-TRAVS-Travel by mile 89 6688.000000 2977.2400 0.4452
Subtotal (Total Children Is Unduplicated) 91 6919.000000 14456.8100 2.0894
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Total 8557.250000 58796.5600 6.8710
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Number of Children (Unduplicated) With at Least One Service 741
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Center 02
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 0 0.000000 0.0000 0.0000
7 7.000000 298.3200 0.0000
Other 3304 8550.250000 58498.2400 0.0000
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Total 3311 8557.250000 58796.5600 0.0000