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
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 706 608.000000 22488.7500 36.9881
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 392 484.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 694 1172.750000 43391.7500 37.0000
Subtotal (Total Children Is Unduplicated) 809 2264.750000 65880.5000 29.0895
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 11.500000 575.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 73.000000 5475.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 80.000000 6000.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 51 91.000000 5050.5000 55.5000
Subtotal (Total Children Is Unduplicated) 106 261.500000 17511.5000 66.9656
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 42.250000 2112.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 26 22.500000 1125.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 5.000000 250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 10.000000 500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 82 431.000000 21550.0000 50.0000
TRAV-TRAVS-Travel by mile 170 11028.00000 4908.7200 0.4451
Subtotal (Total Children Is Unduplicated) 184 11539.00000 30452.4700 2.6391
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Total 14065.250000 113844.4700 8.0940
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Number of Children (Unduplicated) With at Least One Service 840
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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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 5197 14065.250000 113844.4700 0.0000
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Total 5197 14065.250000 113844.4700 0.0000