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
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 712 1134.000000 41930.2500 36.9755
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 594 673.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 217 676.000000 24975.0000 36.9453
Subtotal (Total Children Is Unduplicated) 929 2483.500000 66905.2500 26.9399
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 8.500000 637.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 8.000000 444.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 17.500000 1312.5000 75.0000
Subtotal (Total Children Is Unduplicated) 26 43.500000 3017.5000 69.3678
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 59 52.500000 2625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 3.000000 75.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 290 526.250000 26225.0000 49.8337
CONIP-CONIP-CONSULT, ITDS PHONE 39 16.500000 412.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 4 8.000000 586.5600 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 520 1741.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 34 83.250000 4162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 571 3048.000000 30470.0000 9.9967
Subtotal (Total Children Is Unduplicated) 582 5481.500000 64631.5600 11.7909
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Total 8008.500000 134554.3100 16.8014
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Number of Children (Unduplicated) With at Least One Service 997
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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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
10336 8008.500000 134554.3100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10336 8008.500000 134554.3100 0.0000