CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 Page: 1
List order: No List
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 36 68.500000 2534.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 20 27.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 34 122.000000 4514.0000 37.0000
Subtotal (Total Children Is Unduplicated) 37 218.000000 7048.5000 32.3326
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 15.000000 1125.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 5.000000 375.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 20.000000 1110.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 150.0000 50.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 26 51.000000 3316.5500 65.0304
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9 11.000000 110.0000 10.0000
TRAV-TRAVS-Travel by mile 1 56.000000 24.7900 0.4427
Subtotal (Total Children Is Unduplicated) 10 67.000000 134.7900 2.0118
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Total 336.000000 10499.8400 31.2495
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Number of Children (Unduplicated) With at Least One Service 39
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Center 51
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 52 45.500000 1794.5000 0.0000
P 43 95.500000 1712.8400 1712.8400
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
234 195.000000 6992.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 329 336.000000 10499.8400 1712.8400