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
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 706 608.000000 22488.7500 36.9881
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 392 484.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 158 260.000000 9620.0000 37.0000
Subtotal (Total Children Is Unduplicated) 746 1352.000000 32108.7500 23.7491
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 11.500000 575.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 20.000000 1500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 21.500000 1193.2500 55.5000
Subtotal (Total Children Is Unduplicated) 27 61.000000 3868.2500 63.4139
-----------------------------------------------------------------------------------------------------------------------
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 32 162.250000 8112.5000 50.0000
TRAV-TRAVS-Travel by mile 170 11028.00000 4908.7200 0.4451
Subtotal (Total Children Is Unduplicated) 182 11270.25000 17014.9700 1.5097
-----------------------------------------------------------------------------------------------------------------------
Total 12683.250000 52991.9700 4.1781
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 787
-----------------------------------------------------------------------------------------------------------------------
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 3353 12683.250000 52991.9700 0.0000
---------------------------------------------------------
Total 3353 12683.250000 52991.9700 0.0000