CMS/EIP Fiscal Report Center: 06
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 65 37.500000 1387.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 42 33.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 73 241.750000 8944.7500 37.0000
Subtotal (Total Children Is Unduplicated) 74 312.750000 10332.2500 33.0368
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 54.500000 4087.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 25.500000 1912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 25.000000 1875.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 45.000000 2497.5000 55.5000
Subtotal (Total Children Is Unduplicated) 59 150.000000 10372.5000 69.1500
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1 2.000000 20.0000 10.0000
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Total 464.750000 20724.7500 44.5933
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Number of Children (Unduplicated) With at Least One Service 74
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Center 06
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 2 2.000000 20.0000 20.0000
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
538 462.750000 20704.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 540 464.750000 20724.7500 20.0000