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
Payclass Filters:GR
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 62 234.500000 8676.5000 37.0000
Subtotal (Total Children Is Unduplicated) 111 329.250000 9536.7500 28.9651
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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-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 21.000000 1406.8500 66.9929
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 24.000000 1276.5000 53.1875
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 16.000000 1104.9200 69.0575
Subtotal (Total Children Is Unduplicated) 35 73.000000 4659.0200 63.8222
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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 1204.250000 17286.9200 14.3549
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Number of Children (Unduplicated) With at Least One Service 118
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Center 01
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 78 703.000000 3946.2300 3946.2300
D 15 92.000000 652.2400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 26.500000 94.2000 94.2000
469 382.750000 12594.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 564 1204.250000 17286.9200 4040.4300