CMS/EIP Fiscal Report Center: 02
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 35 33.500000 1239.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 24 34.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 16 40.750000 1507.7500 37.0000
Subtotal (Total Children Is Unduplicated) 37 109.000000 2747.2500 25.2041
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
Subtotal (Total Children Is Unduplicated) 13 36.500000 2464.5000 67.5205
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 3.000000 150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 2.000000 20.0000 10.0000
TRAV-TRAVS-Travel by mile 32 2708.000000 1204.9200 0.4449
Subtotal (Total Children Is Unduplicated) 32 2713.000000 1374.9200 0.5068
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Total 2858.500000 6586.6700 2.3042
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Number of Children (Unduplicated) With at Least One Service 40
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Center 02
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 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 61 2123.000000 2869.0300 2869.0300
0 0.000000 0.0000 0.0000
Other 195 735.500000 3717.6400 0.0000
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Total 256 2858.500000 6586.6700 2869.0300