CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2015 ending 06/30/2016 Date of Report:08/06/2016 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 1448 3674.000000 135255.7500 36.8143
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1316 8218.250000 804.7500 0.0979
TCM-T1017TL-TARGETED CASE MANAGEMENT 1642 9097.000000 334452.2500 36.7651
Subtotal (Total Children Is Unduplicated) 1732 20989.25000 470512.7500 22.4168
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 7.000000 339.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 35 52.750000 2637.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 70 193.000000 14475.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 71 187.500000 14062.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 19 37.000000 2775.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 83 182.500000 10128.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 81 160.000000 12000.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 74.500000 5587.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 325 549.000000 30414.0000 55.3989
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 337 618.000000 46275.0000 74.8786
Subtotal (Total Children Is Unduplicated) 653 2073.250000 139594.7500 67.3314
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 20.9800 20.9800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 206 290.750000 14506.2500 49.8925
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 6.000000 150.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 591 1705.750000 84543.7500 49.5640
CONIP-CONIP-CONSULT, ITDS PHONE 108 48.250000 1206.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 14.000000 700.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 16 52.000000 3812.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 30 98.000000 2450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 514 6030.500000 301937.5000 50.0684
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 976 10836.00000 108212.0000 9.9863
TRAV-TRAVS-Travel by mile 1 6.000000 2.6700 0.4450
Subtotal (Total Children Is Unduplicated) 980 19088.25000 517542.0400 27.1131
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Total 42150.750000 1127649.5400 26.7528
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Number of Children (Unduplicated) With at Least One Service 1732
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Center 53
Flag Claims Units Chgs Paid
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R 315 256.500000 9441.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3523 3439.750000 154073.5000 3172.7500
P 9193 8495.250000 379236.7500 378915.3300
D 0 0.000000 0.0000 0.0000
S 3 4.000000 101.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 6665 5147.000000 81754.9700 81694.9700
31899 24572.750000 497418.5700 130.5000
Other 246 235.500000 5622.5000 0.0000
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Total 51844 42150.750000 1127649.5400 463913.5500