CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 779 638.000000 23606.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 280 333.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 826 1025.500000 37943.5000 37.0000
Subtotal (Total Children Is Unduplicated) 942 1997.000000 61549.5000 30.8210
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 10 11.500000 575.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 59.500000 4462.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 56 108.000000 8100.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 115 209.500000 11627.2500 55.5000
Subtotal (Total Children Is Unduplicated) 152 398.500000 25436.7500 63.8312
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 20 29.500000 1475.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 19 16.500000 825.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 20.750000 1037.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 23 18.500000 925.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 83 329.000000 16450.0000 50.0000
TRAV-TRAVS-Travel by mile 234 13873.00000 6172.0700 0.4449
Subtotal (Total Children Is Unduplicated) 247 14288.75000 26922.0700 1.8841
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Total 16684.250000 113908.3200 6.8273
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Number of Children (Unduplicated) With at Least One Service 993
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Center 02
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
0 0.000000 0.0000 0.0000
Other 5311 16684.250000 113908.3200 0.0000
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Total 5311 16684.250000 113908.3200 0.0000