CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 ending 06/30/2019 Date of Report:07/21/2019 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 218 389.500000 14337.5000 36.8100
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 273 382.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 89 443.750000 16326.2500 36.7915
Subtotal (Total Children Is Unduplicated) 282 1216.000000 30663.7500 25.2169
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Screening, Eval, and Assessment,Class #02
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-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 30.500000 1692.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 29.000000 2175.0000 75.0000
Subtotal (Total Children Is Unduplicated) 26 70.500000 4614.7500 65.4574
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.000000 150.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 3.250000 162.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 0.500000 25.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.750000 37.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 240 269.250000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 266 553.000000 5530.0000 10.0000
TRAV-TRAVS-Travel by mile 86 917.000000 408.0700 0.4450
Subtotal (Total Children Is Unduplicated) 267 1747.750000 6363.0700 3.6407
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Total 3034.250000 41641.5700 13.7238
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Number of Children (Unduplicated) With at Least One Service 285
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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 150 644.250000 1750.5200 1750.5200
T 76 319.750000 1095.8000 1095.8000
2564 2070.250000 38795.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2790 3034.250000 41641.5700 2846.3200