CMS/EIP Fiscal Report Center: 55
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 952 908.750000 33614.5000 36.9898
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 305 231.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1107 3528.250000 130472.2500 36.9793
Subtotal (Total Children Is Unduplicated) 1188 4668.000000 164086.7500 35.1514
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 11 15.000000 750.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 29 37.000000 1850.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 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 141 279.359733 20951.9800 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 0.163200 12.2400 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 20.473600 1535.5200 75.0000
Subtotal (Total Children Is Unduplicated) 199 371.996533 26443.7400 71.0860
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 17 16.250000 812.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 15.750000 787.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 71 497.750000 24887.5000 50.0000
Subtotal (Total Children Is Unduplicated) 73 532.750000 26562.5000 49.8592
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Total 5572.746533 217092.9900 38.9562
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Number of Children (Unduplicated) With at Least One Service 1196
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Center 55
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 931 729.500000 30554.5000 0.0000
P 2782 2345.500000 95911.2500 95681.0000
D 0 0.000000 0.0000 0.0000
S 1 1.303467 97.7600 0.0000
H 8 16.000000 1200.0000 0.0000
T 0 0.000000 0.0000 0.0000
4126 2480.443066 89329.4800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7848 5572.746533 217092.9900 95681.0000