CMS/EIP Fiscal Report Center: 06
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 60 49.500000 1831.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 44 39.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 70 260.750000 9647.7500 37.0000
Subtotal (Total Children Is Unduplicated) 70 349.750000 11479.2500 32.8213
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 55.000000 4125.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 20.000000 1500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 59.500000 3302.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 53 140.500000 9377.2500 66.7420
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EI Services,Class #03
INTR-T1013-INTERPRETER 4 8.000000 494.0000 61.7500
Subtotal (Total Children Is Unduplicated) 4 8.000000 494.0000 61.7500
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Total 498.250000 21350.5000 42.8510
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Number of Children (Unduplicated) With at Least One Service 71
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Center 06
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 3 6.000000 377.0000 377.0000
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
563 492.250000 20973.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 566 498.250000 21350.5000 377.0000