CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 40 39.250000 1452.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 32 46.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 14 21.250000 786.2500 37.0000
Subtotal (Total Children Is Unduplicated) 43 107.000000 2238.5000 20.9206
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 12.500000 937.5000 75.0000
Subtotal (Total Children Is Unduplicated) 11 31.000000 2081.2500 67.1371
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 5.000000 250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 2.000000 20.0000 10.0000
TRAV-TRAVS-Travel by mile 30 2128.000000 947.0500 0.4450
Subtotal (Total Children Is Unduplicated) 30 2135.000000 1217.0500 0.5700
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Total 2273.000000 5536.8000 2.4359
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Number of Children (Unduplicated) With at Least One Service 46
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Center 02
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 32 668.500000 1755.5700 1755.5700
0 0.000000 0.0000 0.0000
Other 212 1604.500000 3781.2300 0.0000
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Total 244 2273.000000 5536.8000 1755.5700