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
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 67 66.250000 2451.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 46 54.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 27 97.000000 3589.0000 37.0000
Subtotal (Total Children Is Unduplicated) 84 217.500000 6040.2500 27.7713
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 20.000000 1500.0000 75.0000
Subtotal (Total Children Is Unduplicated) 18 57.500000 3971.2500 69.0652
-----------------------------------------------------------------------------------------------------------------------
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
-----------------------------------------------------------------------------------------------------------------------
Total 319.500000 10161.5000 31.8044
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 86
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 16 16.500000 233.2500 233.2500
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
361 300.500000 9835.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 378 319.500000 10161.5000 233.2500