CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
Eligibility Filter:DEI Only
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 7 6.000000 222.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 3.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8 17.750000 656.7500 37.0000
Subtotal (Total Children Is Unduplicated) 9 26.750000 878.7500 32.8505
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 0.500000 37.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
Subtotal (Total Children Is Unduplicated) 1 1.500000 93.0000 62.0000
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EI Services,Class #03
TRAV-TRAVS-Travel by mile 1 115.000000 51.1800 0.4450
Subtotal (Total Children Is Unduplicated) 1 115.000000 51.1800 0.4450
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Total 143.250000 1022.9300 7.1409
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Number of Children (Unduplicated) With at Least One Service 9
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Center 02
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 2 115.000000 51.1800 51.1800
0 0.000000 0.0000 0.0000
Other 8 5.250000 138.7500 0.0000
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Total 10 120.250000 189.9300 51.1800
Center 04
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 2 4.750000 175.7500 175.7500
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
8 5.250000 231.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10 10.000000 407.5000 175.7500
Center 06
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
12 5.500000 175.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 12 5.500000 175.7500 0.0000
Center 51
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 6 2.000000 74.0000 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
4 2.000000 74.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10 4.000000 148.0000 0.0000
Center 53
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 3 2.750000 101.7500 101.7500
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
1 0.750000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4 3.500000 101.7500 101.7500