CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
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 21 9.000000 333.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 37 41.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 104 339.000000 12543.0000 37.0000
Subtotal (Total Children Is Unduplicated) 104 389.750000 12876.0000 33.0366
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 64.6700 32.3350
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 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 16 26.000000 1744.6500 67.1019
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 54 80.000000 4356.7500 54.4594
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 72.500000 5362.5000 73.9655
Subtotal (Total Children Is Unduplicated) 70 190.500000 12142.0700 63.7379
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EI Services,Class #03
INTR-T1013-INTERPRETER 7 13.500000 662.5000 49.0741
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 4.000000 40.0000 10.0000
TRAV-TRAVS-Travel by mile 17 565.000000 242.4700 0.4292
Subtotal (Total Children Is Unduplicated) 19 582.500000 944.9700 1.6223
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Total 1162.750000 25963.0400 22.3290
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Number of Children (Unduplicated) With at Least One Service 110
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Center 01
Flag Claims Units Chgs Paid
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R 15 8.500000 314.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 44 53.250000 3800.0000 0.0000
P 310 790.250000 11661.3600 11661.3600
D 5 9.500000 107.1400 0.0000
S 3 38.000000 15.6400 0.0000
H 6 8.000000 600.0000 0.0000
T 5 9.750000 513.9000 501.4000
257 200.500000 6258.0000 0.0000
Other 33 45.000000 2692.5000 0.0000
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Total 678 1162.750000 25963.0400 12162.7600