CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 535 604.500000 22366.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 265 335.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 554 869.750000 32143.7500 36.9575
Subtotal (Total Children Is Unduplicated) 666 1809.250000 54510.2500 30.1286
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 11 14.750000 737.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 28.500000 2137.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 34 63.000000 3496.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 60 116.250000 7082.5000 60.9247
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 15.750000 787.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 20 17.250000 862.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 4.500000 225.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 79 371.500000 18575.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 4.500000 321.4800 71.4400
TRAV-TRAVS-Travel by mile 111 5478.000000 2438.7900 0.4452
Subtotal (Total Children Is Unduplicated) 117 5891.500000 23210.2700 3.9396
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Total 7817.000000 84803.0200 10.8485
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Number of Children (Unduplicated) With at Least One Service 704
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Center 02
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
0 0.000000 0.0000 0.0000
Other 3824 7817.000000 84803.0200 0.0000
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Total 3824 7817.000000 84803.0200 0.0000