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:OTHER    
    Eligibility Filter:Part C (excluding not eligible)
 
 
Services                                              Number of            Number of    Fee Reported          Avg Fee
                                                      Children             Units                              Per/Unit
 
Screening, Eval, and Assessment,Class #02
  SCREEN-T1023-SCREENING                                   1               1.000000           50.0000           50.0000
Subtotal (Total Children Is Unduplicated)                  1               1.000000           50.0000           50.0000
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EI Services,Class #03
  CONIF-CONIF-CONSULT, ITDS FACE TO FACE                   2               2.000000          100.0000           50.0000
  CONPF-CONPF-CONSULT, PT, FACE TO FACE                    1               1.000000           50.0000           50.0000
  EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF            1               1.000000           50.0000           50.0000
  NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE               2               2.000000           20.0000           10.0000
  OCCT-97530-OT SESSION BY LICENSED OT                     1               1.000000           71.4400           71.4400
  SPL-92507-SPL THERAPY SESSION BY LICENSED SLP            2               2.000000          142.8800           71.4400
  TRAV-TRAVS-Travel by mile                               10             253.000000          112.5500            0.4449
Subtotal (Total Children Is Unduplicated)                 16             262.000000          546.8700            2.0873
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Total                                                                    263.000000          596.8700            2.2695
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Number of Children (Unduplicated) With at Least One Service         16
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Center 52
Flag      Claims          Units         Chgs         Paid
---------------------------------------------------------
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 
              22     263.000000     596.8700      55.6800 
Other          0       0.000000       0.0000       0.0000 
---------------------------------------------------------
Total         22     263.000000     596.8700      55.6800