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
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 708 563.000000 20831.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 286 328.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 753 952.250000 35233.2500 37.0000
Subtotal (Total Children Is Unduplicated) 873 1843.500000 56064.2500 30.4119
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 8 9.000000 450.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 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 25 44.500000 3337.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 97.000000 7275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 177.500000 9851.2500 55.5000
Subtotal (Total Children Is Unduplicated) 126 332.000000 21174.7500 63.7794
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 17.000000 850.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 16 13.000000 650.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 25 26.000000 1300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 7 3.250000 81.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 41 27.500000 1375.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 0.750000 18.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 73 298.000000 14900.0000 50.0000
TRAV-TRAVS-Travel by mile 195 14045.00000 6250.9600 0.4451
Subtotal (Total Children Is Unduplicated) 221 14431.25000 25444.7100 1.7632
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Total 16606.750000 102683.7100 6.1833
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Number of Children (Unduplicated) With at Least One Service 933
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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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 4543 16606.750000 102683.7100 0.0000
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Total 4543 16606.750000 102683.7100 0.0000