CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
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 50 54.250000 2007.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 40 34.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 59 188.000000 6946.7500 36.9508
Subtotal (Total Children Is Unduplicated) 63 276.500000 8954.0000 32.3834
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 22.000000 1610.0000 73.1818
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 30 58.500000 3246.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 39.000000 2925.0000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 43 122.500000 7942.7500 64.8388
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 11 11.000000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 14 20.000000 200.0000 10.0000
Subtotal (Total Children Is Unduplicated) 23 31.000000 200.0000 6.4516
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Total 430.000000 17096.7500 39.7599
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Number of Children (Unduplicated) With at Least One Service 69
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Center 07
Flag Claims Units Chgs Paid
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R 8 5.000000 185.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 28.250000 1310.2500 0.0000
P 137 175.000000 8134.0000 8184.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
276 211.750000 6717.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 450 430.000000 17096.7500 8184.0000