CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2017 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 230 367.000000 13579.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 276 533.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 85 403.750000 14938.7500 37.0000
Subtotal (Total Children Is Unduplicated) 288 1303.750000 28517.7500 21.8736
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 8.500000 637.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 7.500000 562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 49.500000 2747.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 23 38.500000 2887.5000 75.0000
Subtotal (Total Children Is Unduplicated) 43 110.000000 7230.5000 65.7318
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.500000 25.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 18.250000 912.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 189 245.500000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 265 612.000000 6120.0000 10.0000
TRAV-TRAVS-Travel by mile 105 2901.000000 1291.2700 0.4451
Subtotal (Total Children Is Unduplicated) 266 3777.750000 8361.2700 2.2133
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Total 5191.500000 44109.5200 8.4965
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Number of Children (Unduplicated) With at Least One Service 291
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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 187 1760.250000 2300.4900 2300.4900
T 133 1182.750000 2545.8100 2545.8100
2500 2246.250000 39179.9700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2822 5191.500000 44109.5200 4846.3000