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
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 708 563.000000 20831.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 286 328.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 187 252.750000 9351.7500 37.0000
Subtotal (Total Children Is Unduplicated) 764 1144.000000 30182.7500 26.3835
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 8 9.000000 450.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 30.500000 2287.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 42.000000 2331.0000 55.5000
Subtotal (Total Children Is Unduplicated) 40 92.000000 5856.0000 63.6522
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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 30 120.000000 6000.0000 50.0000
TRAV-TRAVS-Travel by mile 195 14045.00000 6250.9600 0.4451
Subtotal (Total Children Is Unduplicated) 221 14253.25000 16544.7100 1.1608
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Total 15489.250000 52583.4600 3.3948
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Number of Children (Unduplicated) With at Least One Service 833
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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 3017 15489.250000 52583.4600 0.0000
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Total 3017 15489.250000 52583.4600 0.0000