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
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 1848 4250.000000 157093.7500 36.9632
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1618 3755.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 707 2852.000000 105394.5000 36.9546
Subtotal (Total Children Is Unduplicated) 2172 10857.75000 262488.2500 24.1752
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 7.000000 339.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 11 9.750000 487.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 27 24.000000 1800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 18.000000 1350.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 7.000000 388.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 18.000000 1350.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 16.500000 1237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 64.500000 3579.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 69.000000 5175.0000 75.0000
Subtotal (Total Children Is Unduplicated) 120 249.750000 16907.7500 67.6987
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 151 166.500000 8325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 730 2227.500000 111231.2500 49.9355
CONIP-CONIP-CONSULT, ITDS PHONE 101 57.250000 1431.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 3.250000 162.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 0.500000 25.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.250000 31.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 19 54.000000 3959.2800 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1015 6087.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 25.750000 643.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 152 805.951800 40284.5900 49.9839
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1215 13135.00000 131311.0000 9.9970
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
TRAV-TRAVS-Travel by mile 2 41.000000 18.2500 0.4451
Subtotal (Total Children Is Unduplicated) 1218 22612.95180 297707.0600 13.1653
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Total 33720.451800 577103.0600 17.1143
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Number of Children (Unduplicated) With at Least One Service 2181
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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 7 5.750000 212.7500 0.0000
D 1 1.000000 71.4400 0.0000
S 17 15.500000 573.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
43815 33688.201800 575695.3700 50.0000
Other 9 10.000000 550.0000 0.0000
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Total 43849 33720.451800 577103.0600 50.0000