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
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 535 604.500000 22366.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 265 335.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 129 213.500000 7899.5000 37.0000
Subtotal (Total Children Is Unduplicated) 581 1153.000000 30266.0000 26.2498
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 11 14.750000 737.5000 50.0000
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 5 10.000000 750.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.000000 721.5000 55.5000
Subtotal (Total Children Is Unduplicated) 22 41.750000 2470.0000 59.1617
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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 30 124.250000 6212.5000 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) 115 5644.250000 10847.7700 1.9219
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Total 6839.000000 43583.7700 6.3728
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Number of Children (Unduplicated) With at Least One Service 625
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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 2493 6839.000000 43583.7700 0.0000
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Total 2493 6839.000000 43583.7700 0.0000