CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 ending 09/30/2018 Date of Report:11/06/2018 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 830 1010.500000 37323.7500 36.9359
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 517 683.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 888 2281.000000 84276.7500 36.9473
Subtotal (Total Children Is Unduplicated) 1076 3975.000000 121600.5000 30.5913
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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 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 44.500000 3337.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 18 41.000000 3075.0000 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 10 21.500000 1612.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 18.000000 999.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 52.000000 3900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 30.500000 2287.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 97 166.500000 9240.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 101 182.000000 13650.0000 75.0000
Subtotal (Total Children Is Unduplicated) 207 571.000000 39175.7500 68.6090
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 20.000000 975.0000 48.7500
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 2.250000 56.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 258 276.500000 13787.5000 49.8644
CONIP-CONIP-CONSULT, ITDS PHONE 20 7.750000 193.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 157 98.250000 4900.0000 49.8728
CONOP-CONOP-CONSULT, OT, PHONE 15 6.250000 156.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 167 105.000000 5250.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 117 68.750000 3437.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 19.000000 1393.0800 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 566 1943.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 12.250000 306.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 357 2040.750000 102062.5000 50.0123
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 628 3548.000000 35480.0000 10.0000
Subtotal (Total Children Is Unduplicated) 632 8151.250000 168073.0800 20.6193
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Total 12697.250000 328849.3300 25.8993
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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 160 157.000000 7242.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 987 920.750000 41556.2500 0.0000
P 2387 2266.605800 104326.7900 103244.5600
D 38 38.500000 2091.6000 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11506 9048.894200 159130.1900 0.0000
Other 239 265.000000 14483.5000 0.0000
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Total 15318 12697.250000 328849.3300 103244.5600