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
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 398 211.000000 7807.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 286 195.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 268 757.000000 28009.0000 37.0000
Subtotal (Total Children Is Unduplicated) 669 1163.750000 35816.0000 30.7764
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 12 12.000000 600.0000 50.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.500000 100.5800 40.2320
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 23 27.500000 1400.9300 50.9429
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 86 87.250000 4362.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 59 74.750000 3737.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 26 31.000000 1550.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 33 37.000000 1850.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 61 99.000000 4950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 98 142.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 38.250000 1912.5000 50.0000
INTR-T1013-INTERPRETER 3 32.250000 1612.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 351 1960.000000 19600.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 1 6.750000 482.2200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 14.000000 1000.1600 71.4400
TRAV-TRAVS-Travel by mile 367 26028.00000 11585.3300 0.4451
Subtotal (Total Children Is Unduplicated) 446 28552.50000 52698.9600 1.8457
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Total 29743.750000 89915.8900 3.0230
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Number of Children (Unduplicated) With at Least One Service 803
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 11 10.250000 530.3500 0.0000
S 3 1.500000 55.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 2955 28008.500000 47347.1500 44487.6100
2881 1723.500000 41982.8900 120.8900
Other 0 0.000000 0.0000 0.0000
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Total 5850 29743.750000 89915.8900 44608.5000