CMS/EIP Fiscal Report Center: 52
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 306 170.000000 6280.7500 36.9456
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 266 176.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 291 794.000000 29137.5000 36.6971
Subtotal (Total Children Is Unduplicated) 602 1140.750000 35418.2500 31.0482
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 4 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
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 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 11 21.000000 1322.0000 62.9524
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 56.250000 2812.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 39 67.500000 3375.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 25.750000 1287.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 16 14.500000 725.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 38 52.000000 2600.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.250000 6.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 65 89.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 49.000000 2450.0000 50.0000
INTR-T1013-INTERPRETER 12 84.000000 4200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 222 1237.000000 12370.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 6.000000 428.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 20.500000 1464.5200 71.4400
TRAV-TRAVS-Travel by mile 285 20859.00000 9281.0500 0.4449
Subtotal (Total Children Is Unduplicated) 338 22562.50000 41031.7100 1.8186
-----------------------------------------------------------------------------------------------------------------------
Total 23724.250000 77771.9600 3.2782
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 683
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 57 44.000000 1544.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 1713 22450.750000 41019.5400 35949.3900
1827 1229.500000 35207.6700 36.6700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3597 23724.250000 77771.9600 35986.0600