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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 498 919.000000 34003.0000 37.0000
Subtotal (Total Children Is Unduplicated) 498 919.000000 34003.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 34 66.000000 3663.0000 55.5000
Subtotal (Total Children Is Unduplicated) 36 70.000000 3885.0000 55.5000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 47 260.250000 13012.5000 50.0000
Subtotal (Total Children Is Unduplicated) 48 262.250000 13062.5000 49.8093
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Total 1251.250000 50950.5000 40.7197
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Number of Children (Unduplicated) With at Least One Service 508
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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
2 2.000000 50.0000 0.0000
Other 1692 1249.250000 50900.5000 0.0000
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Total 1694 1251.250000 50950.5000 0.0000