CMS/EIP Fiscal Report Center: 53
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 69 100.250000 3709.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 86 126.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 26 119.000000 4403.0000 37.0000
Subtotal (Total Children Is Unduplicated) 96 346.000000 8112.2500 23.4458
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 5.500000 305.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.000000 450.0000 75.0000
Subtotal (Total Children Is Unduplicated) 5 11.500000 755.2500 65.6739
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 3 5.500000 275.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 65 87.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 85 198.000000 1980.0000 10.0000
TRAV-TRAVS-Travel by mile 34 988.000000 439.8100 0.4452
Subtotal (Total Children Is Unduplicated) 86 1280.500000 2794.8100 2.1826
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Total 1638.000000 11662.3100 7.1198
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Number of Children (Unduplicated) With at Least One Service 100
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Center 53
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 81 586.750000 826.1500 826.1500
T 40 441.500000 571.0600 571.0600
695 609.750000 10265.1000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 816 1638.000000 11662.3100 1397.2100