CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 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 42 74.000000 2720.0000 36.7568
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 9.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 15 55.000000 2035.0000 37.0000
Subtotal (Total Children Is Unduplicated) 45 138.750000 4755.0000 34.2703
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 100.0000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 20.000000 1110.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 14 41.500000 2526.2500 60.8735
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 9 14.500000 0.0000 0.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 9.000000 90.0000 10.0000
Subtotal (Total Children Is Unduplicated) 14 23.500000 90.0000 3.8298
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Total 203.750000 7371.2500 36.1779
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Number of Children (Unduplicated) With at Least One Service 48
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Center 07
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 11 13.000000 301.0000 301.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 300.0000 0.0000
T 0 0.000000 0.0000 0.0000
265 186.750000 6770.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 278 203.750000 7371.2500 301.0000