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
Agency Filter:EIP DEI DEIP
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 797 1111.000000 41071.0000 36.9676
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 621 736.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1001 2680.500000 99132.2500 36.9827
Subtotal (Total Children Is Unduplicated) 1102 4527.750000 140203.2500 30.9653
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 3 2.250000 112.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 19.500000 1462.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 22.000000 1650.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.500000 1087.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 28.000000 1554.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 37 61.000000 4575.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 22.000000 1650.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 18.000000 1350.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 95 165.500000 9185.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 102 189.000000 14175.0000 75.0000
Subtotal (Total Children Is Unduplicated) 204 544.250000 36962.7500 67.9150
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 36 24.750000 1237.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 312 590.000000 29500.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 25 14.500000 362.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 3.250000 162.5000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 20.000000 1466.4000 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 554 1913.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 22 35.750000 893.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 350 1932.000000 96587.0000 49.9933
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 608 3619.000000 36171.0000 9.9947
Subtotal (Total Children Is Unduplicated) 611 8153.000000 166380.6500 20.4073
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Total 13225.000000 343546.6500 25.9771
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Number of Children (Unduplicated) With at Least One Service 1144
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Center 53
Flag Claims Units Chgs Paid
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R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 16 13.500000 647.5000 0.0000
P 3869 3533.306600 159167.5800 158694.4100
D 0 0.000000 0.0000 0.0000
S 27 23.500000 972.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
12255 9514.193400 174789.3200 0.0000
Other 115 139.000000 7901.2500 0.0000
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Total 16284 13225.000000 343546.6500 158694.4100