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
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 882 985.750000 36472.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 317 291.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 309 1215.750000 44982.7500 37.0000
Subtotal (Total Children Is Unduplicated) 983 2493.250000 81455.5000 32.6704
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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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 36.250531 2718.7900 75.0000
Subtotal (Total Children Is Unduplicated) 32 45.250531 3168.7900 70.0277
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 62.500000 3125.0000 50.0000
Subtotal (Total Children Is Unduplicated) 17 62.500000 3125.0000 50.0000
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Total 2601.000531 87749.2900 33.7367
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Number of Children (Unduplicated) With at Least One Service 983
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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 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
4366 2601.000531 87749.2900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4366 2601.000531 87749.2900 0.0000