CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 705 581.000000 21497.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 293 386.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 150 229.000000 8473.0000 37.0000
Subtotal (Total Children Is Unduplicated) 732 1196.500000 29970.0000 25.0481
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 14.500000 725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 14 24.000000 1332.0000 55.5000
Subtotal (Total Children Is Unduplicated) 33 66.000000 4119.5000 62.4167
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 20.500000 1025.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 31 21.000000 1050.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 16 10.500000 525.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 31 17.250000 862.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.750000 18.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 140.500000 7025.0000 50.0000
TRAV-TRAVS-Travel by mile 178 10704.00000 4764.2300 0.4451
Subtotal (Total Children Is Unduplicated) 192 10915.00000 15282.9800 1.4002
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Total 12177.500000 49372.4800 4.0544
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Number of Children (Unduplicated) With at Least One Service 771
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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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 2979 12177.500000 49372.4800 0.0000
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Total 2979 12177.500000 49372.4800 0.0000