CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2016 ending 09/30/2016 Date of Report:10/31/2016 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 689 839.000000 31016.0000 36.9678
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 783 2635.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 945 2922.500000 107679.2500 36.8449
Subtotal (Total Children Is Unduplicated) 1064 6396.500000 138695.2500 21.6830
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 6 7.750000 387.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 40.500000 2887.5000 71.2963
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 39.000000 2925.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 12.500000 937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 45.000000 2497.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 35.500000 2662.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 15.500000 1162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 12.500000 937.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 111 212.000000 11766.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 130 229.000000 17175.0000 75.0000
Subtotal (Total Children Is Unduplicated) 215 649.250000 43338.5000 66.7516
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 65.500000 3275.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 301 599.000000 29950.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 18 8.000000 200.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 8.000000 400.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 20 55.000000 4032.6000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 20.000000 500.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 340 1812.500000 90687.5000 50.0345
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 592 3495.000000 34930.0000 9.9943
TRAV-TRAVS-Travel by mile 1 1.000000 0.4500 0.4500
Subtotal (Total Children Is Unduplicated) 594 6065.250000 164031.8000 27.0445
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Total 13111.000000 346065.5500 26.3951
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Number of Children (Unduplicated) With at Least One Service 1064
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Center 53
Flag Claims Units Chgs Paid
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R 2 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1895 1776.250000 81669.7900 0.0000
P 1900 1749.000000 77322.0000 77272.0000
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
11952 9583.500000 186990.5100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 15749 13111.000000 346065.5500 77272.0000