CMS/EIP Fiscal Report Center: 54
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 43 37.500000 1387.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 123 131.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 39 176.250000 6521.2500 37.0000
Subtotal (Total Children Is Unduplicated) 138 345.250000 7908.7500 22.9073
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 13.000000 721.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 8.000000 600.0000 75.0000
Subtotal (Total Children Is Unduplicated) 18 39.000000 2671.5000 68.5000
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.250000 62.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 111 115.750000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 119 238.000000 2380.0000 10.0000
TRAV-TRAVS-Travel by mile 75 1172.000000 521.3200 0.4448
Subtotal (Total Children Is Unduplicated) 119 1527.250000 2976.3200 1.9488
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Total 1911.500000 13556.5700 7.0921
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Number of Children (Unduplicated) With at Least One Service 139
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Center 54
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 1 0.750000 0.0000 55.5000
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 150 1042.000000 1669.9100 1669.9100
814 868.750000 11886.6600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 965 1911.500000 13556.5700 1725.4100