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
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 1334 1056.250000 39081.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 734 612.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1593 4302.500000 159008.2500 36.9572
Subtotal (Total Children Is Unduplicated) 1704 5971.250000 198089.5000 33.1739
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 12.500000 937.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 195 294.500000 22087.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 102 162.000000 12150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 220 346.500000 19175.2500 55.3398
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 33 54.000000 4050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 284 890.000000 59723.2500 67.1048
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Total 6861.250000 257812.7500 37.5752
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Number of Children (Unduplicated) With at Least One Service 1704
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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 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
11136 6861.250000 257812.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11136 6861.250000 257812.7500 0.0000