CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2016 ending 06/30/2016 Date of Report:08/06/2016 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 53 51.500000 1905.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 77 246.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 85 384.000000 14208.0000 37.0000
Subtotal (Total Children Is Unduplicated) 87 682.250000 16113.5000 23.6182
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 48 81.500000 4523.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 91.000000 6825.0000 75.0000
Subtotal (Total Children Is Unduplicated) 67 206.500000 13830.0000 66.9734
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 12.750000 637.5000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 140.0000 70.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 70 137.000000 1370.0000 10.0000
TRAV-TRAVS-Travel by mile 23 673.000000 299.5600 0.4451
Subtotal (Total Children Is Unduplicated) 70 825.750000 2497.0600 3.0240
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Total 1714.500000 32440.5600 18.9213
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Number of Children (Unduplicated) With at Least One Service 87
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Center 53
Flag Claims Units Chgs Paid
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R 7 8.000000 296.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 100 111.250000 6265.0000 0.0000
P 162 166.250000 6609.5000 6609.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 75 729.000000 1974.0600 1974.0600
T 184 166.750000 2966.2500 2966.2500
499 533.250000 14329.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1027 1714.500000 32440.5600 11549.8100