CMS/EIP Fiscal Report Center: 57
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 496 582.250000 21543.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 257 191.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1573 6264.500000 231786.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1601 7037.750000 253329.7500 35.9958
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 132 165.000000 8250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 31.500000 2362.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 53 64.500000 4837.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 41.500000 2303.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 215 234.000000 17530.5000 74.9167
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 61 69.500000 5212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 328 401.000000 22255.5000 55.5000
Subtotal (Total Children Is Unduplicated) 490 1007.000000 62751.7500 62.3155
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 8.000000 400.0000 50.0000
Subtotal (Total Children Is Unduplicated) 3 8.000000 400.0000 50.0000
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Total 8052.750000 316481.5000 39.3010
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Number of Children (Unduplicated) With at Least One Service 1605
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Center 57
Flag Claims Units Chgs Paid
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R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 362 430.000000 16690.7500 55.0000
P 3342 3867.250000 155281.2500 151937.2700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 11.500000 862.5000 0.0000
T 0 0.000000 0.0000 0.0000
3599 3742.500000 143591.5000 0.0000
Other 1 0.500000 18.5000 18.5000
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Total 7314 8052.750000 316481.5000 152010.7700