CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
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 68 30.750000 1137.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 61 58.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 152 431.750000 15974.7500 37.0000
Subtotal (Total Children Is Unduplicated) 154 520.500000 17112.5000 32.8770
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 33.000000 2475.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 13.000000 975.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 6.000000 333.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 23 62.500000 4570.5000 73.1280
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EI Services,Class #03
INTR-T1013-INTERPRETER 4 23.500000 937.5000 39.8936
Subtotal (Total Children Is Unduplicated) 4 23.500000 937.5000 39.8936
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Total 606.500000 22620.5000 37.2968
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Number of Children (Unduplicated) With at Least One Service 155
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Center 03
Flag Claims Units Chgs Paid
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R 4 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 283 275.000000 12300.0000 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
431 328.500000 10209.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 718 606.500000 22620.5000 0.0000