CMS/EIP Fiscal Report Center: 57
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
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 502 286.250000 10591.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 145 117.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1483 5998.250000 221935.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1543 6401.500000 232526.5000 36.3238
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 134 239.000000 11950.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 20.500000 1537.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 23.500000 1304.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 261 285.000000 21375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 242 294.500000 16344.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 35.500000 2662.5000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
Subtotal (Total Children Is Unduplicated) 438 906.000000 55630.3000 61.4021
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 111.000000 7929.8400 71.4400
Subtotal (Total Children Is Unduplicated) 14 112.000000 7979.8400 71.2486
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Total 7419.500000 296136.6400 39.9133
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Number of Children (Unduplicated) With at Least One Service 1553
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Center 57
Flag Claims Units Chgs Paid
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R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2167 2631.500000 98693.2500 0.0000
P 318 333.250000 20399.7500 20210.5500
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
4235 4454.250000 177025.1400 8215.1500
Other 0 0.000000 0.0000 0.0000
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Total 6721 7419.500000 296136.6400 28425.7000