CMS/EIP Fiscal Report Center: 57
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 25 11.250000 416.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 22 12.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 45 239.000000 8843.0000 37.0000
Subtotal (Total Children Is Unduplicated) 60 263.000000 9259.2500 35.2063
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 4.500000 337.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 5.500000 305.2500 55.5000
Subtotal (Total Children Is Unduplicated) 5 11.000000 717.7500 65.2500
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EI Services,Class #03
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 5 22.000000 220.0000 10.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 2.500000 92.5000 37.0000
Subtotal (Total Children Is Unduplicated) 5 24.500000 312.5000 12.7551
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Total 298.500000 10289.5000 34.4707
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Number of Children (Unduplicated) With at Least One Service 62
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Center 57
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 12 24.500000 312.5000 312.5000
220 274.000000 9977.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 232 298.500000 10289.5000 312.5000