CMS/EIP Fiscal Report Center: 52
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 17 10.750000 397.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 21 18.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 70 285.500000 10554.2500 36.9676
Subtotal (Total Children Is Unduplicated) 70 314.250000 10952.0000 34.8512
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 96.000000 6690.0000 69.6875
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 36.000000 2360.0000 65.5556
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 31.500000 1892.5000 60.0794
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 101.500000 5522.2500 54.4064
Subtotal (Total Children Is Unduplicated) 59 304.000000 19126.5000 62.9161
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11 23.000000 230.0000 10.0000
TRAV-TRAVS-Travel by mile 39 1261.000000 561.3000 0.4451
Subtotal (Total Children Is Unduplicated) 41 1284.000000 791.3000 0.6163
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Total 1902.250000 30869.8000 16.2280
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Number of Children (Unduplicated) With at Least One Service 70
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Center 52
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 56 98.000000 6167.7500 0.0000
P 177 212.000000 8982.7600 8849.9700
D 6 11.000000 649.5000 0.0000
S 2 4.000000 300.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 106 1315.500000 2502.2000 2499.2000
234 259.750000 12117.5900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 582 1902.250000 30869.8000 11349.1700