CMS/EIP Fiscal Report Center: 03
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 718 407.500000 15077.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 350 317.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 433 1237.500000 45787.5000 37.0000
Subtotal (Total Children Is Unduplicated) 978 1962.250000 60865.0000 31.0180
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 71 87.250000 4362.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 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 6 9.500000 527.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 64 121.500000 9112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 30 56.000000 4200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 50 92.500000 5133.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.000000 1425.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 45 46.000000 2300.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 202 449.750000 28291.2500 62.9044
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 60 58.750000 2937.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 13 26.750000 1337.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 10 5.750000 143.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 180 293.750000 14687.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 33 35.500000 1775.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 10.750000 268.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 258 328.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 57.250000 2862.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 4.250000 212.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 6.000000 414.4000 69.0667
PHY-97110-PT SESSION BY LICENSED PT 2 7.500000 535.8000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 31.250000 2117.3800 67.7562
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 142.8800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 28 2103.000000 935.5900 0.4449
Subtotal (Total Children Is Unduplicated) 288 2972.750000 28394.9300 9.5517
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Total 5384.750000 117551.1800 21.8304
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Number of Children (Unduplicated) With at Least One Service 1110
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Center 03
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 1 1.000000 50.0000 50.0000
T 0 0.000000 0.0000 0.0000
5256 5383.750000 117501.1800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5257 5384.750000 117551.1800 50.0000