CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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 753 808.750000 29923.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 217 299.750000 11090.7500 37.0000
Subtotal (Total Children Is Unduplicated) 791 1108.500000 41014.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 19.500000 1462.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 17 33.500000 1859.2500 55.5000
SCREEN-T1023-SCREENING 9 9.000000 450.0000 50.0000
Subtotal (Total Children Is Unduplicated) 29 88.000000 5657.7500 64.2926
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.750000 37.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 10 10.750000 537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.500000 37.5000 25.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 29 24.500000 1225.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 19 12.500000 625.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 35 26.000000 1300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 117.750000 5887.5000 50.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 21 22.750000 841.7500 37.0000
Subtotal (Total Children Is Unduplicated) 84 216.500000 10491.7500 48.4607
-----------------------------------------------------------------------------------------------------------------------
Total 1413.000000 57164.0000 40.4558
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 831
-----------------------------------------------------------------------------------------------------------------------
Center 02
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
0 0.000000 0.0000 0.0000
Other 3090 1413.000000 57164.0000 0.0000
---------------------------------------------------------
Total 3090 1413.000000 57164.0000 0.0000