CMS/EIP Fiscal Report Center: 06
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
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 1426 837.000000 30969.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 472 360.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 855 1990.250000 73626.7500 36.9937
Subtotal (Total Children Is Unduplicated) 1815 3187.750000 104595.7500 32.8118
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 17.500000 1312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 22.000000 1650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 15.000000 832.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 14.500000 1087.5000 75.0000
Subtotal (Total Children Is Unduplicated) 25 72.500000 5145.0000 70.9655
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Total 3260.250000 109740.7500 33.6602
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Number of Children (Unduplicated) With at Least One Service 1815
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Center 06
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
6076 3260.250000 109740.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6076 3260.250000 109740.7500 0.0000