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
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 415 184.250000 6817.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 218 163.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 613 2379.500000 88041.5000 37.0000
Subtotal (Total Children Is Unduplicated) 973 2727.500000 94858.7500 34.7786
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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 2 2.500000 187.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 2.500000 138.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 21.500000 1612.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 28.500000 1581.7500 55.5000
Subtotal (Total Children Is Unduplicated) 137 221.500000 11995.5000 54.1558
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1 1.000000 50.0000 50.0000
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Total 2950.000000 106904.2500 36.2387
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Number of Children (Unduplicated) With at Least One Service 1023
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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 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 0 0.000000 0.0000 0.0000
3141 2950.000000 106904.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3141 2950.000000 106904.2500 0.0000