CMS/EIP Fiscal Report Center: 07
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 113 86.750000 3209.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 92 278.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 135 585.000000 21635.7500 36.9842
Subtotal (Total Children Is Unduplicated) 146 949.750000 24845.5000 26.1600
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 179.6500 71.8600
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 60 109.500000 6077.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 67 142.500000 10687.5000 75.0000
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
Subtotal (Total Children Is Unduplicated) 96 301.000000 20057.6500 66.6367
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-T1013-INTERPRETER 1 3.000000 250.0000 83.3333
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 26 35.000000 350.0000 10.0000
TRAV-TRAVS-Travel by mile 1 24.000000 10.6800 0.4450
Subtotal (Total Children Is Unduplicated) 26 62.000000 610.6800 9.8497
-----------------------------------------------------------------------------------------------------------------------
Total 1312.750000 45513.8300 34.6706
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 146
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 15 13.000000 481.0000 0.0000
P 600 666.000000 29132.3300 29132.3300
D 11 12.000000 444.0000 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
652 621.750000 15456.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1278 1312.750000 45513.8300 29132.3300