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
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 1128 870.500000 32171.5000 36.9575
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 642 869.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 470 1592.500000 58709.7500 36.8664
Subtotal (Total Children Is Unduplicated) 1389 3332.750000 90881.2500 27.2691
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 44 64.500000 3225.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 71.000000 3940.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 128.500000 9637.5000 75.0000
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 119 287.000000 18320.7500 63.8354
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 6.500000 325.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.750000 18.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 9.000000 450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11 17.250000 843.7500 48.9130
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Total 3637.000000 110045.7500 30.2573
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Number of Children (Unduplicated) With at Least One Service 1389
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Center 07
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 76 55.250000 2309.2500 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
5991 3581.750000 107736.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6067 3637.000000 110045.7500 0.0000