CMS/EIP Fiscal Report Center: 55
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 745 763.500000 28249.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 246 203.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 969 3071.750000 113645.5000 36.9970
Subtotal (Total Children Is Unduplicated) 1001 4038.250000 141895.0000 35.1377
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 2.750000 137.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 4 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 121 241.500000 18112.5003 75.0000
Subtotal (Total Children Is Unduplicated) 134 260.250000 19350.0003 74.3516
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EI Services,Class #03
CONIP-CONIP-CONSULT, ITDS PHONE 3 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 55 321.000000 16050.0000 50.0000
Subtotal (Total Children Is Unduplicated) 63 327.500000 16237.5000 49.5802
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Total 4626.000000 177482.5003 38.3663
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Number of Children (Unduplicated) With at Least One Service 1001
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Center 55
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 21 15.000000 555.0000 0.0000
P 2861 2580.000000 105127.2500 105127.2500
D 14 26.750000 1977.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 9 16.990400 1274.2800 0.0000
T 0 0.000000 0.0000 0.0000
3206 1987.259600 68548.2203 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6111 4626.000000 177482.5003 105127.2500