CMS/EIP Fiscal Report Center: 52
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
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 477 290.500000 10694.2500 36.8133
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 726 2483.750000 91778.5000 36.9516
Subtotal (Total Children Is Unduplicated) 789 2777.000000 102472.7500 36.9005
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 48.000000 3600.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 70 144.000000 10591.0000 73.5486
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 25.000000 1875.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 999.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 33 64.500000 3635.2500 56.3605
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
SCREEN-T1023-SCREENING 11 11.000000 550.0000 50.0000
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 124 353.500000 24339.4000 68.8526
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 4.500000 225.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 21 21.750000 1087.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 28 27.000000 675.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 15 17.500000 875.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 15 19.250000 962.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.000000 25.0000 25.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 3.750000 187.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.750000 18.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 14 17.500000 875.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 13.500000 675.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 24 43.500000 2175.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 2.750000 68.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 27 33.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 52 161.750000 8087.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 40 119.000000 5950.0000 50.0000
INTR-T1013-INTERPRETER 5 35.000000 1750.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 73 223.000000 2230.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 3.000000 214.3200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 5 23.500000 1678.8400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 55.750000 3982.7800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 26 160.250000 11139.6200 69.5140
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 9 36.750000 2625.4200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 16 65.500000 4679.3200 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 6 10.500000 388.5000 37.0000
TRAV-TRAVS-Travel by mile 103 3929.000000 1748.0600 0.4449
Subtotal (Total Children Is Unduplicated) 197 5033.750000 52558.3000 10.4412
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Total 8164.250000 179370.4500 21.9702
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Number of Children (Unduplicated) With at Least One Service 800
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Center 52
Flag Claims Units Chgs Paid
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R 3 6.000000 450.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1333 1360.500000 60598.7000 0.0000
P 287 269.500000 10895.7000 10765.3200
D 0 0.000000 0.0000 0.0000
S 334 363.500000 14303.0000 46.7500
H 46 51.750000 3544.0200 0.0000
T 732 4579.250000 27911.2300 20904.5600
2095 1533.750000 61667.8000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4830 8164.250000 179370.4500 31716.6300