CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 45 23.250000 860.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 73 71.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 126 580.250000 21387.0000 36.8583
Subtotal (Total Children Is Unduplicated) 127 675.000000 22247.2500 32.9589
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 47.500000 3394.3500 71.4600
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 8.500000 637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 19.500000 1462.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 58.500000 3191.2500 54.5513
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 44.500000 3242.4200 72.8634
Subtotal (Total Children Is Unduplicated) 72 188.500000 12629.2700 66.9988
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EI Services,Class #03
INTR-T1013-INTERPRETER 23 54.000000 2662.5000 49.3056
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9 11.000000 110.0000 10.0000
TRAV-TRAVS-Travel by mile 25 737.000000 318.6500 0.4324
Subtotal (Total Children Is Unduplicated) 40 802.000000 3091.1500 3.8543
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Total 1665.500000 37967.6700 22.7966
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Number of Children (Unduplicated) With at Least One Service 129
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Center 01
Flag Claims Units Chgs Paid
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R 3 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 362 282.000000 10455.0000 0.0000
P 79 704.500000 4029.4800 4029.4800
D 51 145.000000 4110.4900 0.0000
S 87 107.250000 5572.5000 0.0000
H 8 11.000000 825.0000 0.0000
T 2 26.500000 94.2000 94.2000
474 387.750000 12825.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1066 1665.500000 37967.6700 4123.6800