CMS/EIP Fiscal Report Center: 07
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 55 62.750000 2321.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 34 31.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 63 213.500000 7871.7500 36.8700
Subtotal (Total Children Is Unduplicated) 65 307.750000 10193.5000 33.1227
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
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 12 22.500000 1687.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 31 61.000000 3385.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 46.500000 3487.5000 75.0000
Subtotal (Total Children Is Unduplicated) 46 138.000000 9082.5000 65.8152
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 11 15.750000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 19 30.000000 300.0000 10.0000
TRAV-TRAVS-Travel by mile 1 26.000000 11.5700 0.4450
Subtotal (Total Children Is Unduplicated) 27 71.750000 311.5700 4.3424
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Total 517.500000 19587.5700 37.8504
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Number of Children (Unduplicated) With at Least One Service 67
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Center 07
Flag Claims Units Chgs Paid
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R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 76 101.000000 4858.7500 0.0000
P 98 152.300000 5042.8200 5042.8200
D 6 8.500000 427.5000 0.0000
S 4 4.500000 138.7500 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
317 248.200000 8932.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 503 517.500000 19587.5700 5042.8200