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
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 36 68.500000 2534.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 20 27.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 17 70.250000 2599.2500 37.0000
Subtotal (Total Children Is Unduplicated) 37 166.250000 5133.7500 30.8797
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 8.000000 600.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 3.000000 225.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 10.000000 555.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 13 26.000000 1680.0000 64.6154
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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 259.250000 6948.5400 26.8025
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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 0 0.000000 0.0000 0.0000
P 25 79.000000 995.7900 995.7900
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
219 180.250000 5952.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 244 259.250000 6948.5400 995.7900