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
Agency Filter:EIP DEI DEIP
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 584 877.000000 32430.5000 36.9789
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 170 186.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 615 1741.000000 64185.7500 36.8672
Subtotal (Total Children Is Unduplicated) 730 2804.750000 96616.2500 34.4474
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 42 42.000000 2100.0000 50.0000
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 3 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 15.000000 1125.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 89.500000 4967.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 141 154.000000 8646.2500 56.1445
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 43.000000 2150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 1.500000 75.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 119.000000 8501.3600 71.4400
Subtotal (Total Children Is Unduplicated) 36 164.500000 10776.3600 65.5098
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Total 3123.250000 116038.8600 37.1532
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Number of Children (Unduplicated) With at Least One Service 761
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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 1062 783.250000 32870.3300 0.0000
P 364 292.000000 11422.5000 11273.7500
D 14 12.500000 538.0000 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
2811 2034.500000 71136.5900 0.0000
Other 1 1.000000 71.4400 0.0000
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Total 4252 3123.250000 116038.8600 11273.7500