CMS/EIP Fiscal Report Center: 53
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 67 90.250000 3339.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 73 85.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 83 333.000000 12321.0000 37.0000
Subtotal (Total Children Is Unduplicated) 85 509.000000 15660.2500 30.7667
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 9.500000 712.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 76.500000 4245.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 83.000000 6225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 60 189.500000 12672.0000 66.8707
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 48 62.000000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 60 114.000000 1140.0000 10.0000
TRAV-TRAVS-Travel by mile 24 548.000000 243.9200 0.4451
Subtotal (Total Children Is Unduplicated) 60 724.000000 1383.9200 1.9115
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Total 1422.500000 29716.1700 20.8901
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Number of Children (Unduplicated) With at Least One Service 85
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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 44 31.750000 1174.7500 0.0000
P 239 265.750000 12474.5000 12362.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 48 371.000000 533.2300 533.2300
T 22 184.000000 510.6300 510.6300
616 570.000000 15023.0600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 969 1422.500000 29716.1700 13405.8600