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
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 1334 1055.500000 39053.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 734 612.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 583 1628.250000 60245.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1537 3296.250000 99298.7500 30.1248
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 10.500000 787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 9.500000 712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 11 35.000000 2361.7500 67.4786
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Total 3331.250000 101660.5000 30.5172
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Number of Children (Unduplicated) With at Least One Service 1537
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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
6477 3331.250000 101660.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6477 3331.250000 101660.5000 0.0000