CMS/EIP Fiscal Report Center: 55
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 1057 1242.250000 45963.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 336 276.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1168 4189.500000 155011.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1239 5708.500000 200974.7500 35.2062
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 16 19.000000 950.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 33 37.000000 1850.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 141 280.402667 21030.2000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 24.930667 1869.8000 75.0000
Subtotal (Total Children Is Unduplicated) 210 379.333334 27050.0000 71.3093
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 27 30.500000 1525.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 30.500000 1525.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 78 522.750000 26137.5000 50.0000
Subtotal (Total Children Is Unduplicated) 80 583.750000 29187.5000 50.0000
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Total 6671.583334 257212.2500 38.5534
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Number of Children (Unduplicated) With at Least One Service 1240
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Center 55
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 1576 1315.000000 55135.7500 77.7500
P 2657 2157.666667 86324.5000 89842.9300
D 0 0.000000 0.0000 0.0000
S 2 2.666666 200.0000 0.0000
H 3 6.000000 450.0000 0.0000
T 1 0.750000 27.7500 27.7500
5228 3189.500001 115074.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9467 6671.583334 257212.2500 89948.4300