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
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 689 839.000000 31016.0000 36.9678
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 783 2629.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 225 661.000000 24420.0000 36.9440
Subtotal (Total Children Is Unduplicated) 967 4129.250000 55436.0000 13.4252
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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 10 13.000000 825.0000 63.4615
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 13.000000 975.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 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 6 10.000000 750.0000 75.0000
Subtotal (Total Children Is Unduplicated) 46 78.250000 4959.5000 63.3802
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 56 64.500000 3225.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 301 597.250000 29862.5000 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
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 25 62.000000 3100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 592 3487.000000 34850.0000 9.9943
TRAV-TRAVS-Travel by mile 1 1.000000 0.4500 0.4500
Subtotal (Total Children Is Unduplicated) 594 4233.000000 71794.2000 16.9606
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Total 8440.500000 132189.7000 15.6614
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Number of Children (Unduplicated) With at Least One Service 974
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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 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
10915 8440.500000 132189.7000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10915 8440.500000 132189.7000 0.0000