CMS/EIP Fiscal Report Center: 07
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 67 66.250000 2451.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 46 54.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 85 315.750000 11682.7500 37.0000
Subtotal (Total Children Is Unduplicated) 93 436.250000 14134.0000 32.3989
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 44.500000 3337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 51.500000 2858.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 49.500000 3712.5000 75.0000
Subtotal (Total Children Is Unduplicated) 53 169.500000 11513.2500 67.9248
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 23 29.500000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 12 15.000000 150.0000 10.0000
Subtotal (Total Children Is Unduplicated) 33 44.500000 150.0000 3.3708
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Total 650.250000 25797.2500 39.6728
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Number of Children (Unduplicated) With at Least One Service 93
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Center 07
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 1 0.500000 18.5000 0.0000
P 289 344.000000 15748.7500 15748.7500
D 1 2.500000 92.5000 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
365 303.250000 9937.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 656 650.250000 25797.2500 15748.7500