CMS/EIP Fiscal Report Center: 54
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 51 32.000000 1184.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 138 135.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 160 752.250000 27740.7500 36.8770
Subtotal (Total Children Is Unduplicated) 161 919.750000 28924.7500 31.4485
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 11.000000 825.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 10.500000 787.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 17.000000 943.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 53 78.000000 5850.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 44 57.000000 4275.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 17.000000 1275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 80 118.000000 6549.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 56.500000 4237.5000 75.0000
Subtotal (Total Children Is Unduplicated) 136 380.500000 25905.0000 68.0815
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 127 102.500000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 135 261.000000 2610.0000 10.0000
TRAV-TRAVS-Travel by mile 93 1403.000000 624.0800 0.4448
Subtotal (Total Children Is Unduplicated) 136 1766.500000 3234.0800 1.8308
-----------------------------------------------------------------------------------------------------------------------
Total 3066.750000 58063.8300 18.9333
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 161
-----------------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 6.750000 249.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 313 327.250000 15200.7500 37.0000
P 293 297.000000 13229.5000 13229.5000
D 4 5.500000 383.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 139 1056.500000 2557.1100 2557.1100
1054 1348.750000 25481.4700 0.0000
Other 26 25.000000 962.0000 0.0000
---------------------------------------------------------
Total 1833 3066.750000 58063.8300 15823.6100