CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 29 13.000000 481.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 41 42.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 65 237.250000 8778.2500 37.0000
Subtotal (Total Children Is Unduplicated) 97 292.500000 9259.2500 31.6556
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 15.000000 1125.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 40.500000 2220.0000 54.8148
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 22.500000 1687.5000 75.0000
Subtotal (Total Children Is Unduplicated) 29 78.000000 5032.5000 64.5192
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
INTR-T1013-INTERPRETER 22 41.250000 2037.5000 49.3939
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 6.000000 60.0000 10.0000
TRAV-TRAVS-Travel by mile 16 583.000000 248.2800 0.4259
Subtotal (Total Children Is Unduplicated) 36 632.250000 2445.7800 3.8684
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Total 1002.750000 16737.5300 16.6916
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Number of Children (Unduplicated) With at Least One Service 106
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Center 01
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 65 605.500000 2241.0500 2241.0500
D 1 1.500000 112.5000 0.0000
S 3 20.000000 117.4800 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 75.0000 75.0000
449 374.750000 14191.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 519 1002.750000 16737.5300 2316.0500