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
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 566 354.750000 13125.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 299 250.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 688 2995.500000 110833.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1140 3600.750000 123959.2500 34.4260
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 125 140.250000 7012.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 10.500000 787.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 19.000000 1054.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 145 182.250000 9772.5000 53.6214
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Total 3783.000000 133731.7500 35.3507
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Number of Children (Unduplicated) With at Least One Service 1199
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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 3 1.000000 37.0000 37.0000
D 1 0.500000 18.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 0.250000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4332 3781.250000 133676.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4337 3783.000000 133731.7500 37.0000