CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2018 ending 06/30/2018 Date of Report:08/10/2018 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 81.500000 3015.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 81 166.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 93 374.500000 13856.5000 37.0000
Subtotal (Total Children Is Unduplicated) 96 622.750000 16872.0000 27.0927
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 26.000000 1950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 14.500000 1087.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 54 85.000000 4717.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 81.500000 6112.5000 75.0000
Subtotal (Total Children Is Unduplicated) 73 225.500000 15108.7500 67.0011
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 70 73.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 4.000000 200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 76 155.000000 1550.0000 10.0000
TRAV-TRAVS-Travel by mile 26 617.000000 274.6400 0.4451
Subtotal (Total Children Is Unduplicated) 76 849.000000 2024.6400 2.3847
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Total 1697.250000 34005.3900 20.0356
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Number of Children (Unduplicated) With at Least One Service 98
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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 1 0.250000 9.2500 9.2500
P 328 346.750000 16518.7500 16406.2500
D 0 0.000000 0.0000 0.0000
S 2 2.250000 83.2500 0.0000
H 18 103.000000 141.4000 141.4000
T 34 387.500000 722.0200 722.0200
705 848.500000 15904.4700 0.0000
Other 6 9.000000 626.2500 0.0000
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Total 1094 1697.250000 34005.3900 17278.9200