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
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 760 1083.500000 40024.7500 36.9402
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 735 2622.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 215 520.750000 19156.7500 36.7868
Subtotal (Total Children Is Unduplicated) 969 4226.750000 59181.5000 14.0017
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 9 15.500000 775.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 16.000000 1200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 14.000000 1050.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 18.000000 999.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 16.500000 1237.5000 75.0000
Subtotal (Total Children Is Unduplicated) 52 93.500000 6157.0000 65.8503
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 77 87.000000 4325.0000 49.7126
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 313 680.500000 33962.5000 49.9082
CONIP-CONIP-CONSULT, ITDS PHONE 20 11.000000 275.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 14.000000 700.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 4 7.000000 513.2400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 10.000000 250.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 24 54.750000 2737.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 558 3836.000000 38360.0000 10.0000
TRAV-TRAVS-Travel by mile 1 6.000000 2.6700 0.4450
Subtotal (Total Children Is Unduplicated) 558 4706.500000 81132.1600 17.2383
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Total 9026.750000 146470.6600 16.2263
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Number of Children (Unduplicated) With at Least One Service 975
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Center 53
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 1.750000 10.0000 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 3783 2906.500000 45486.0300 45476.0300
8073 6118.500000 100974.6300 130.5000
Other 0 0.000000 0.0000 0.0000
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Total 11858 9026.750000 146470.6600 45606.5300