CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2016 ending 06/30/2017 Date of Report:08/05/2017 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 1811 3989.500000 147385.0000 36.9432
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1647 10688.25000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 566 2500.750000 92287.2500 36.9038
Subtotal (Total Children Is Unduplicated) 2145 17178.50000 239672.2500 13.9519
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 4 6.000000 300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 46 61.250000 3062.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 38 42.000000 3000.0000 71.4286
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 54 65.000000 4800.0000 73.8462
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 28.500000 1581.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 39 69.500000 3857.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 40.500000 3037.5000 75.0000
Subtotal (Total Children Is Unduplicated) 176 339.250000 21626.5000 63.7480
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 213 283.000000 14112.5000 49.8675
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 746 2379.000000 118843.5000 49.9552
CONIP-CONIP-CONSULT, ITDS PHONE 121 69.500000 1737.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 8.000000 400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 30 170.000000 12464.4000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 24.500000 612.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 91 578.445000 28922.2500 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1232 14496.00000 144890.0000 9.9952
TRAV-TRAVS-Travel by mile 1 1.000000 0.4500 0.4500
Subtotal (Total Children Is Unduplicated) 1235 18015.44500 322158.1000 17.8823
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Total 35533.195000 583456.8500 16.4201
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Number of Children (Unduplicated) With at Least One Service 2148
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Center 53
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 287 302.000000 15849.8500 0.0000
D 36 36.000000 1823.3200 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
46650 35194.195000 565773.6800 40494.7500
Other 1 1.000000 10.0000 0.0000
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Total 46974 35533.195000 583456.8500 40494.7500