CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 Page: 1
List order: No List
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 45 47.500000 1757.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 37 59.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 41 122.000000 4406.0000 36.1148
Subtotal (Total Children Is Unduplicated) 46 229.250000 6163.5000 26.8855
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 13.000000 975.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 16.500000 1237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 21.500000 1193.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
Subtotal (Total Children Is Unduplicated) 25 63.500000 4236.0000 66.7087
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EI Services,Class #03
INTR-T1013-INTERPRETER 3 8.000000 400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 2.000000 20.0000 10.0000
TRAV-TRAVS-Travel by mile 30 1800.000000 801.1000 0.4451
Subtotal (Total Children Is Unduplicated) 32 1810.000000 1221.1000 0.6746
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Total 2102.750000 11620.6000 5.5264
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Number of Children (Unduplicated) With at Least One Service 47
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Center 02
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 34 526.500000 1358.1600 1358.1600
1 77.000000 34.2700 0.0000
Other 389 1499.250000 10228.1700 0.0000
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Total 424 2102.750000 11620.6000 1358.1600