CMS/EIP Fiscal Report Center: 52
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 319 145.500000 5383.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 187 129.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 294 883.750000 32534.2500 36.8139
Subtotal (Total Children Is Unduplicated) 575 1158.250000 37917.7500 32.7371
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 15 30.000000 2073.0500 69.1017
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 43 40.500000 2025.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 2.750000 68.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 38 59.250000 2962.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.250000 6.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 18.500000 925.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 9.500000 475.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 45 72.750000 3637.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.250000 6.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 33 52.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 34.750000 1737.5000 50.0000
INTR-T1013-INTERPRETER 11 83.500000 4175.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 213 1164.000000 11640.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 12.000000 857.2800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 142.8800 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 2.750000 101.7500 37.0000
TRAV-TRAVS-Travel by mile 281 18149.00000 8074.9400 0.4449
Subtotal (Total Children Is Unduplicated) 308 19706.00000 36978.4800 1.8765
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Total 20894.250000 76969.2800 3.6838
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Number of Children (Unduplicated) With at Least One Service 688
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Center 52
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 2 18.250000 17.2600 17.2600
D 0 0.000000 0.0000 0.0000
S 50 42.500000 1572.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 1752 19642.500000 37859.0200 33381.1800
1750 1191.000000 37520.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3554 20894.250000 76969.2800 33398.4400