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
Payclass Filters:GR
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 351 1259.250000 46592.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1126 2778.250000 92555.5000 33.3143
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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 32 36.000000 1800.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.636800 422.7600 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 29.725599 2229.4200 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 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 72 94.362399 5702.1800 60.4285
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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 29 180.000000 9000.0000 50.0000
Subtotal (Total Children Is Unduplicated) 47 241.000000 12050.0000 50.0000
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Total 3113.612399 110307.6800 35.4276
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Number of Children (Unduplicated) With at Least One Service 1129
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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 1 0.250000 9.2500 0.0000
P 1 0.250000 9.2500 9.2500
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 0 0.000000 0.0000 0.0000
5155 3113.112399 110289.1800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5157 3113.612399 110307.6800 9.2500