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
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 724 929.500000 34308.2500 36.9104
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 689 1640.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 175 476.500000 17556.5000 36.8447
Subtotal (Total Children Is Unduplicated) 972 3046.250000 51864.7500 17.0258
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 6.000000 291.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 3 2.250000 112.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 5.000000 375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 9.500000 527.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 12.000000 900.0000 75.0000
Subtotal (Total Children Is Unduplicated) 23 39.250000 2523.7500 64.2994
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 63.000000 3150.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 291 518.750000 25925.0000 49.9759
CONIP-CONIP-CONSULT, ITDS PHONE 7 3.750000 93.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 5.000000 366.6000 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 290 641.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 47.750000 2387.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 575 3070.000000 30700.0000 10.0000
TRAV-TRAVS-Travel by mile 2 41.000000 18.2500 0.4451
Subtotal (Total Children Is Unduplicated) 579 4393.500000 62753.6000 14.2833
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Total 7479.000000 117142.1000 15.6628
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Number of Children (Unduplicated) With at Least One Service 989
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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 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
9835 7479.000000 117142.1000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9835 7479.000000 117142.1000 0.0000