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
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 788 680.500000 25178.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 214 254.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 817 1005.500000 37175.7500 36.9724
Subtotal (Total Children Is Unduplicated) 940 1940.500000 62354.2500 32.1331
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 9 14.250000 712.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 50.500000 3787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 47.000000 3525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 65 123.500000 6854.2500 55.5000
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
Subtotal (Total Children Is Unduplicated) 92 255.250000 16103.7500 63.0901
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 15 20.750000 1037.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 3 3.250000 162.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 15 14.000000 700.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 9 7.500000 375.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 22 16.000000 800.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 12 6.500000 325.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 43 25.250000 1262.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 11 6.500000 325.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 71 344.500000 17225.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 22 25.750000 1287.5000 50.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 13 7.750000 286.7500 37.0000
TRAV-TRAVS-Travel by mile 154 11970.00000 5325.5800 0.4449
Subtotal (Total Children Is Unduplicated) 199 12450.25000 29174.8300 2.3433
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Total 14646.000000 107632.8300 7.3490
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Number of Children (Unduplicated) With at Least One Service 990
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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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 5343 14646.000000 107632.8300 0.0000
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Total 5343 14646.000000 107632.8300 0.0000