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
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 830 1010.500000 37323.7500 36.9359
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 517 682.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 286 680.250000 25123.0000 36.9320
Subtotal (Total Children Is Unduplicated) 995 2373.500000 62446.7500 26.3100
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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 10 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 7.500000 562.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.000000 943.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
Subtotal (Total Children Is Unduplicated) 31 67.500000 4640.5000 68.7481
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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 17.000000 1246.4400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 566 1943.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 120.394200 6019.7100 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 628 3548.000000 35480.0000 10.0000
Subtotal (Total Children Is Unduplicated) 632 6219.644200 71652.4000 11.5203
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Total 8660.644200 138739.6500 16.0196
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Number of Children (Unduplicated) With at Least One Service 1094
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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 5 5.000000 366.6000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11268 8655.644200 138373.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11273 8660.644200 138739.6500 0.0000