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
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 952 908.750000 33614.5000 36.9898
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 305 231.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 329 991.500000 36685.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1043 2131.250000 70300.0000 32.9853
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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 28 36.000000 1800.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 30.739333 2305.4500 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.170133 387.7600 75.0000
Subtotal (Total Children Is Unduplicated) 60 88.909466 5354.2100 60.2209
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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 26 186.500000 9325.0000 50.0000
Subtotal (Total Children Is Unduplicated) 40 221.500000 11000.0000 49.6614
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Total 2441.659466 86654.2100 35.4899
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Number of Children (Unduplicated) With at Least One Service 1054
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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 1 0.250000 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
4096 2441.409466 86654.2100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4097 2441.659466 86654.2100 0.0000