CMS/EIP Fiscal Report Center: 52
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 38 18.750000 693.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 31 19.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 89 373.750000 13764.0000 36.8268
Subtotal (Total Children Is Unduplicated) 92 411.500000 14457.7500 35.1343
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 58 120.000000 8286.3600 69.0530
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 32.000000 2400.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 23.000000 1575.0000 68.4783
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 61 116.500000 6415.7500 55.0708
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 67 312.500000 20115.6100 64.3700
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 5.000000 50.0000 10.0000
TRAV-TRAVS-Travel by mile 45 1542.000000 686.4600 0.4452
Subtotal (Total Children Is Unduplicated) 45 1547.500000 736.4600 0.4759
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Total 2271.500000 35309.8200 15.5447
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Number of Children (Unduplicated) With at Least One Service 92
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Center 52
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 9 14.500000 897.5000 0.0000
P 215 272.000000 13047.7500 12691.2400
D 8 14.250000 799.0000 0.0000
S 8 7.750000 286.7500 0.0000
H 26 49.500000 3225.0000 0.0000
T 111 1601.000000 3999.0300 3766.2800
339 312.500000 13054.7900 150.0000
Other 0 0.000000 0.0000 0.0000
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Total 716 2271.500000 35309.8200 16607.5200