CMS/EIP Fiscal Report Center: 53
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 836 1122.500000 41532.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 562 644.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 266 704.000000 26029.5000 36.9737
Subtotal (Total Children Is Unduplicated) 993 2470.500000 67562.0000 27.3475
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 7 7.250000 362.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 13.500000 1012.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
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 6 11.500000 638.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 16.500000 1237.5000 75.0000
Subtotal (Total Children Is Unduplicated) 32 66.250000 4485.2500 67.7019
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 19 14.250000 712.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 249 281.250000 14062.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 15 5.500000 131.5000 23.9091
CONOF-CONOF-CONSULT, OT, FACE TO FACE 166 104.000000 5187.5000 49.8798
CONOP-CONOP-CONSULT, OT, PHONE 18 7.250000 181.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 143 93.250000 4650.0000 49.8660
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 81 54.250000 2712.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 2.000000 50.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 18.000000 1319.7600 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 604 1854.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 8.000000 200.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 80.000000 4000.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 656 3442.000000 34410.0000 9.9971
Subtotal (Total Children Is Unduplicated) 661 5965.750000 67648.7600 11.3395
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Total 8502.500000 139696.0100 16.4300
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Number of Children (Unduplicated) With at Least One Service 1077
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Center 53
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 1 1.000000 73.3200 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
11154 8501.500000 139622.6900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11155 8502.500000 139696.0100 0.0000