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
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 584 877.000000 32430.5000 36.9789
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 170 186.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 264 778.250000 28712.0000 36.8930
Subtotal (Total Children Is Unduplicated) 651 1842.000000 61142.5000 33.1935
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 42 42.000000 2100.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 44 45.000000 2497.5000 55.5000
Subtotal (Total Children Is Unduplicated) 89 93.000000 5047.5000 54.2742
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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 5 16.000000 800.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 0.500000 25.0000 50.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 29.750000 2125.3400 71.4400
Subtotal (Total Children Is Unduplicated) 12 47.250000 3000.3400 63.4993
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Total 1982.250000 69190.3400 34.9050
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Number of Children (Unduplicated) With at Least One Service 664
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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 0 0.000000 0.0000 0.0000
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
2750 1982.250000 69190.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2750 1982.250000 69190.3400 0.0000