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
Payclass Filters:GR
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 33 140.250000 5189.2500 37.0000
Subtotal (Total Children Is Unduplicated) 90 388.500000 8204.7500 21.1190
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 5.500000 412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 20.000000 1110.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 17 45.500000 3022.5000 66.4286
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 70 73.000000 0.0000 0.0000
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) 76 845.000000 1824.6400 2.1593
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Total 1279.000000 13051.8900 10.2048
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Number of Children (Unduplicated) With at Least One Service 95
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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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
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
661 786.250000 12105.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 715 1279.000000 13051.8900 863.4200