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
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 51 32.000000 1184.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 138 135.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 49 243.000000 8917.0000 36.6955
Subtotal (Total Children Is Unduplicated) 148 410.500000 10101.0000 24.6066
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 12.000000 900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 13.000000 975.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 20.500000 1137.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 14.500000 1087.5000 75.0000
Subtotal (Total Children Is Unduplicated) 28 62.000000 4250.2500 68.5524
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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
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Total 2239.000000 17585.3300 7.8541
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Number of Children (Unduplicated) With at Least One Service 153
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Center 54
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 0 0.000000 0.0000 0.0000
T 130 1040.000000 1563.3600 1563.3600
954 1199.000000 16021.9700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1084 2239.000000 17585.3300 1563.3600