CMS/EIP Fiscal Report Center: 06
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 62 43.250000 1600.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 46 35.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 42 161.000000 5957.0000 37.0000
Subtotal (Total Children Is Unduplicated) 75 240.000000 7557.2500 31.4885
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.500000 187.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 5.000000 277.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
Subtotal (Total Children Is Unduplicated) 4 10.000000 652.5000 65.2500
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 4.000000 40.0000 10.0000
Subtotal (Total Children Is Unduplicated) 3 6.000000 140.0000 23.3333
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Total 256.000000 8349.7500 32.6162
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Number of Children (Unduplicated) With at Least One Service 75
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Center 06
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 4 4.000000 40.0000 40.0000
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
336 252.000000 8309.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 340 256.000000 8349.7500 40.0000