CMS/EIP Fiscal Report Center: 06
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 60 35.750000 1322.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 25 17.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 44 154.750000 5725.7500 37.0000
Subtotal (Total Children Is Unduplicated) 71 208.250000 7048.5000 33.8463
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 3.500000 194.2500 55.5000
Subtotal (Total Children Is Unduplicated) 7 19.000000 1356.7500 71.4079
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EI Services,Class #03
INTR-T1013-INTERPRETER 1 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 6 12.000000 120.0000 10.0000
Subtotal (Total Children Is Unduplicated) 7 14.000000 220.0000 15.7143
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Total 241.250000 8625.2500 35.7523
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Number of Children (Unduplicated) With at Least One Service 72
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Center 06
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 13 14.000000 220.0000 220.0000
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
296 227.250000 8405.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 309 241.250000 8625.2500 220.0000