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
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 745 763.500000 28249.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 246 203.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 289 874.750000 32365.7500 37.0000
Subtotal (Total Children Is Unduplicated) 851 1841.250000 60615.2500 32.9207
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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 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 43.505597 3262.9199 75.0000
Subtotal (Total Children Is Unduplicated) 35 52.255597 3750.4199 71.7707
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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 13 95.500000 4775.0000 50.0000
Subtotal (Total Children Is Unduplicated) 22 102.000000 4962.5000 48.6520
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Total 1995.505597 69328.1699 34.7422
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Number of Children (Unduplicated) With at Least One Service 853
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 14 26.750000 1977.7500 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
3187 1968.755597 67350.4199 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3201 1995.505597 69328.1699 0.0000