CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 87 58.250000 2155.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 69 77.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 172.500000 6382.5000 37.0000
Subtotal (Total Children Is Unduplicated) 105 308.250000 8537.7500 27.6975
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.500000 1237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 32.000000 1776.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 52.000000 3900.0000 75.0000
Subtotal (Total Children Is Unduplicated) 34 109.500000 7520.2500 68.6781
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 33 60.750000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 11 17.000000 170.0000 10.0000
TRAV-TRAVS-Travel by mile 1 26.000000 11.5700 0.4450
Subtotal (Total Children Is Unduplicated) 43 103.750000 181.5700 1.7501
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Total 521.500000 16239.5700 31.1401
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Number of Children (Unduplicated) With at Least One Service 107
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Center 07
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 21 48.500000 486.8200 486.8200
D 21 27.500000 1462.2500 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
525 445.500000 14290.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 567 521.500000 16239.5700 486.8200