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
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 798 704.500000 26066.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 311 412.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 152 244.250000 9037.2500 37.0000
Subtotal (Total Children Is Unduplicated) 815 1361.250000 35103.7500 25.7879
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 15 22.000000 1100.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.500000 1162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 34 69.500000 4350.5000 62.5971
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 22.250000 1112.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 24 15.000000 750.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 4.500000 225.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 48 33.250000 1662.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 184.500000 9225.0000 50.0000
TRAV-TRAVS-Travel by mile 178 12532.00000 5577.9300 0.4451
Subtotal (Total Children Is Unduplicated) 202 12791.50000 18552.9300 1.4504
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Total 14222.250000 58007.1800 4.0786
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Number of Children (Unduplicated) With at Least One Service 858
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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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 3403 14222.250000 58007.1800 0.0000
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Total 3403 14222.250000 58007.1800 0.0000