CMS/EIP Fiscal Report Center: 57
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 10 4.250000 157.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4 2.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 54 246.750000 9129.7500 37.0000
Subtotal (Total Children Is Unduplicated) 54 253.750000 9287.0000 36.5990
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 32.500000 2437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 40 43.500000 2414.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 18.500000 1387.5000 75.0000
Subtotal (Total Children Is Unduplicated) 46 96.500000 6369.7500 66.0078
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 6.000000 60.0000 10.0000
TRAV-TRAVS-Travel by mile 1 145.000000 64.5300 0.4450
Subtotal (Total Children Is Unduplicated) 3 151.000000 124.5300 0.8247
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Total 501.250000 15781.2800 31.4839
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Number of Children (Unduplicated) With at Least One Service 57
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Center 57
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 94 119.000000 5722.0000 0.0000
P 31 46.500000 1720.5000 1720.5000
D 0 0.000000 0.0000 0.0000
S 4 4.000000 40.0000 40.0000
H 0 0.000000 0.0000 0.0000
T 5 151.000000 345.5300 345.5300
156 180.750000 7953.2500 522.0000
Other 0 0.000000 0.0000 0.0000
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Total 290 501.250000 15781.2800 2628.0300