CMS/EIP Fiscal Report Center: 55
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 1137 1172.500000 43382.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 281 213.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 373 1258.750000 46573.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1192 2644.250000 89956.2500 34.0196
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 13 18.000000 900.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 40 63.000000 3150.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 33.313867 2498.5399 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 0.836800 62.7600 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.621200 196.5900 75.0000
Subtotal (Total Children Is Unduplicated) 75 117.771867 6807.8899 57.8057
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 2.000000 100.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 28 26.500000 1325.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 9 5.750000 143.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 26.500000 1325.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 9 6.500000 162.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 24 129.500000 6475.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 8.750000 437.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 5.000000 357.2000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 17 8.500000 314.5000 37.0000
Subtotal (Total Children Is Unduplicated) 54 220.000000 10650.4500 48.4111
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Total 2982.021867 107414.5899 36.0207
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Number of Children (Unduplicated) With at Least One Service 1199
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Center 55
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
5336 2982.021867 107414.5899 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5336 2982.021867 107414.5899 0.0000