CMS/EIP Fiscal Report Center: 09
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:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 73 54.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 82 143.750000 5318.7500 37.0000
Subtotal (Total Children Is Unduplicated) 82 198.500000 5318.7500 26.7947
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 37 66.000000 4950.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 76.500000 5737.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 81 144.500000 8019.7500 55.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 81 288.000000 18758.3000 65.1330
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
Subtotal (Total Children Is Unduplicated) 2 2.000000 142.8800 71.4400
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Total 488.500000 24219.9300 49.5802
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Number of Children (Unduplicated) With at Least One Service 85
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Center 09
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 317 487.250000 24173.6800 24173.6800
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
3 1.250000 46.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 320 488.500000 24219.9300 24173.6800