CMS/EIP Fiscal Report Center: 57
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 415 184.250000 6817.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 218 163.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1551 6159.500000 227901.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1572 6507.500000 234718.7500 36.0690
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 110 160.500000 8025.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 26.000000 1950.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 35.500000 1970.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 229 248.000000 18600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 93 112.000000 8400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 317 380.500000 21117.7500 55.5000
Subtotal (Total Children Is Unduplicated) 458 966.500000 60363.0000 62.4553
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.000000 250.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1 6.000000 300.0000 50.0000
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Total 7480.000000 295381.7500 39.4895
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Number of Children (Unduplicated) With at Least One Service 1575
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Center 57
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 199 237.250000 10062.7500 0.0000
P 3500 4021.250000 160819.5000 157299.0300
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
3362 3221.500000 124499.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7061 7480.000000 295381.7500 157299.0300