CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 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 63 85.500000 3145.0000 36.7836
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 82 88.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 31 118.500000 4384.5000 37.0000
Subtotal (Total Children Is Unduplicated) 90 292.750000 7529.5000 25.7199
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
Subtotal (Total Children Is Unduplicated) 6 15.000000 988.5000 65.9000
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 67 70.250000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 75 148.000000 1480.0000 10.0000
TRAV-TRAVS-Travel by mile 25 262.000000 116.5800 0.4450
Subtotal (Total Children Is Unduplicated) 75 480.250000 1596.5800 3.3245
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Total 788.000000 10114.5800 12.8358
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Number of Children (Unduplicated) With at Least One Service 95
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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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 18 81.000000 122.0600 122.0600
T 20 112.000000 219.9400 219.9400
648 595.000000 9772.5800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 686 788.000000 10114.5800 342.0000