CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2019 ending 06/30/2019 Date of Report:07/21/2019 Page: 1
List order: No List
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 66 98.000000 3579.7500 36.5281
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 78 90.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 82 357.500000 13153.5000 36.7930
Subtotal (Total Children Is Unduplicated) 85 546.000000 16733.2500 30.6470
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 25.000000 1875.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 13.500000 1012.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 18.500000 1387.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 66 99.000000 5494.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 42 67.000000 5025.0000 75.0000
Subtotal (Total Children Is Unduplicated) 78 230.500000 15318.0000 66.4555
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 72 69.750000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 78 149.000000 1490.0000 10.0000
TRAV-TRAVS-Travel by mile 26 232.000000 103.1500 0.4446
Subtotal (Total Children Is Unduplicated) 78 450.750000 1593.1500 3.5344
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Total 1227.250000 33644.4000 27.4145
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Number of Children (Unduplicated) With at Least One Service 86
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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 214 234.250000 10931.2500 0.0000
P 105 126.250000 5934.7500 5934.7500
D 0 0.000000 0.0000 0.0000
S 6 7.000000 240.5000 240.5000
H 47 164.000000 395.9000 395.9000
T 0 0.000000 0.0000 0.0000
711 671.250000 14558.0000 0.0000
Other 15 24.500000 1584.0000 0.0000
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Total 1098 1227.250000 33644.4000 6571.1500