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
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 788 680.500000 25178.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 214 254.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 240 284.000000 10480.2500 36.9023
Subtotal (Total Children Is Unduplicated) 843 1219.000000 35658.7500 29.2525
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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 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 13.000000 975.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 33.500000 1859.2500 55.5000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 33 83.250000 5131.2500 61.6366
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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 34 167.750000 8387.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 10.250000 512.5000 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) 198 12258.00000 19562.3300 1.5959
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Total 13560.250000 60352.3300 4.4507
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Number of Children (Unduplicated) With at Least One Service 900
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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 3647 13560.250000 60352.3300 0.0000
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Total 3647 13560.250000 60352.3300 0.0000