CMS/EIP Fiscal Report Center: 55
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
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 882 985.750000 36472.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 317 291.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1029 3785.250000 140054.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1086 5062.750000 176527.0000 34.8678
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 5 5.000000 250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 113 228.000000 17100.0000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 126 246.000000 18201.0500 73.9880
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 60 296.750000 14837.5000 50.0000
Subtotal (Total Children Is Unduplicated) 60 296.750000 14837.5000 50.0000
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Total 5605.500000 209565.5500 37.3857
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Number of Children (Unduplicated) With at Least One Service 1086
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Center 55
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 2 0.750000 27.7500 0.0000
P 3499 2960.500000 118787.7500 118787.7500
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
4403 2644.250000 90750.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7904 5605.500000 209565.5500 118787.7500