CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
Payclass Filters:GR
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 27 13.500000 499.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 40 36.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 51 160.750000 5947.7500 37.0000
Subtotal (Total Children Is Unduplicated) 81 210.250000 6447.2500 30.6647
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.000000 450.0000 75.0000
Subtotal (Total Children Is Unduplicated) 6 13.000000 877.5000 67.5000
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EI Services,Class #03
INTR-T1013-INTERPRETER 23 32.750000 1637.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 3.000000 30.0000 10.0000
TRAV-TRAVS-Travel by mile 20 647.000000 276.5300 0.4274
Subtotal (Total Children Is Unduplicated) 39 682.750000 1944.0300 2.8474
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Total 906.000000 9268.7800 10.2304
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Number of Children (Unduplicated) With at Least One Service 94
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Center 01
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 0 0.000000 0.0000 0.0000
P 52 653.000000 1154.0900 1154.0900
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 1 12.000000 4.9400 4.9400
330 241.000000 8109.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 383 906.000000 9268.7800 1159.0300