CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 Page: 1
List order: No List
Payclass Filters:GR
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 48 44.750000 1655.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 41 69.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 22.250000 823.2500 37.0000
Subtotal (Total Children Is Unduplicated) 50 136.500000 2479.0000 18.1612
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 8 27.000000 1898.2500 70.3056
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 2.500000 125.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 6 7.000000 70.0000 10.0000
TRAV-TRAVS-Travel by mile 32 1734.000000 771.7200 0.4451
Subtotal (Total Children Is Unduplicated) 35 1743.500000 966.7200 0.5545
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Total 1907.000000 5343.9700 2.8023
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Number of Children (Unduplicated) With at Least One Service 50
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Center 02
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 35 412.000000 1238.0400 1241.0400
4 68.500000 300.9800 0.0000
Other 245 1426.500000 3804.9500 0.0000
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Total 284 1907.000000 5343.9700 1241.0400