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
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 226 99.000000 3663.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 87 58.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 543 1948.000000 72076.0000 37.0000
Subtotal (Total Children Is Unduplicated) 708 2105.250000 75739.0000 35.9763
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 98 178.000000 8900.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 75 69.000000 5175.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 91.000000 5050.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 33 33.000000 2475.0000 75.0000
Subtotal (Total Children Is Unduplicated) 201 376.500000 21949.0000 58.2975
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Total 2481.750000 97688.0000 39.3625
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Number of Children (Unduplicated) With at Least One Service 762
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 9 12.500000 462.5000 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
2761 2469.250000 97225.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2770 2481.750000 97688.0000 0.0000