CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2017 ending 09/30/2017 Date of Report:11/05/2017 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 60 82.000000 3034.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 77 151.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 22 62.000000 2294.0000 37.0000
Subtotal (Total Children Is Unduplicated) 86 295.500000 5328.0000 18.0305
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 7.000000 525.0000 75.0000
Subtotal (Total Children Is Unduplicated) 6 15.500000 1026.0000 66.1935
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 8.500000 425.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 10 9.000000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 64 153.000000 1530.0000 10.0000
TRAV-TRAVS-Travel by mile 30 1038.000000 462.0200 0.4451
Subtotal (Total Children Is Unduplicated) 64 1208.500000 2417.0200 2.0000
-----------------------------------------------------------------------------------------------------------------------
Total 1519.500000 8771.0200 5.7723
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 89
-----------------------------------------------------------------------------------------------------------------------
Center 53
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 33 450.500000 427.7300 427.7300
T 31 240.500000 371.7600 371.7600
594 828.500000 7971.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 658 1519.500000 8771.0200 799.4900