CMS/EIP Fiscal Report Center: 52
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 275 133.250000 4911.7500 36.8612
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 186 125.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 680 1755.000000 64324.5000 36.6521
Subtotal (Total Children Is Unduplicated) 734 2013.250000 69236.2500 34.3903
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 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 105 220.000000 15813.1700 71.8780
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 61 137.000000 9559.4800 69.7772
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 26.500000 1824.4900 68.8487
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 69 136.500000 7575.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
SCREEN-T1023-SCREENING 17 17.000000 850.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 155 563.000000 37389.1400 66.4106
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 46 49.500000 2475.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 50 65.500000 3275.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 21.000000 1050.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 24.250000 1212.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 51 64.500000 3225.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.750000 18.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 78 111.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 149 844.750000 42237.5000 50.0000
INTR-T1013-INTERPRETER 8 50.500000 2525.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 230 1221.000000 12210.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 65.000000 4643.6000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 6.000000 428.6400 71.4400
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.000000 525.0000 525.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 69 305.750000 21433.1800 70.1003
TRAV-TRAVS-Travel by mile 297 19473.00000 8664.0400 0.4449
Subtotal (Total Children Is Unduplicated) 354 22305.25000 103960.7100 4.6608
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Total 24881.500000 210586.1000 8.4636
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Number of Children (Unduplicated) With at Least One Service 777
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Center 52
Flag Claims Units Chgs Paid
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R 15 12.750000 743.3900 0.0000
U 0 0.000000 0.0000 0.0000
B 260 259.750000 12169.5800 0.0000
P 1784 1832.750000 85378.5700 82455.5000
D 0 0.000000 0.0000 0.0000
S 117 86.750000 2632.7500 75.0000
H 101 114.000000 7812.1000 0.0000
T 2107 21345.000000 60726.4400 49606.3300
1705 1230.500000 41123.2700 213.2400
Other 0 0.000000 0.0000 0.0000
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Total 6089 24881.500000 210586.1000 132350.0700