CMS/EIP Fiscal Report Statewide
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:DEI Only
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 32 29.750000 1100.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 4 7.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 23 34.250000 1267.2500 37.0000
Subtotal (Total Children Is Unduplicated) 38 71.250000 2368.0000 33.2351
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 0.750000 37.5000 50.0000
Subtotal (Total Children Is Unduplicated) 1 0.750000 37.5000 50.0000
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 2.000000 20.0000 10.0000
TRAV-TRAVS-Travel by mile 1 17.000000 7.5700 0.4453
Subtotal (Total Children Is Unduplicated) 2 19.000000 27.5700 1.4511
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Total 91.000000 2433.0700 26.7370
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Number of Children (Unduplicated) With at Least One Service 39
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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 3 19.000000 27.5700 27.5700
0 0.000000 0.0000 0.0000
Other 33 14.250000 268.2500 0.0000
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Total 36 33.250000 295.8200 27.5700
Center 04
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
78 54.750000 2035.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 78 54.750000 2035.5000 0.0000
Center 06
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
4 3.000000 101.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4 3.000000 101.7500 0.0000