CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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 681 744.750000 27555.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 23 24.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 152 264.000000 9768.0000 37.0000
Subtotal (Total Children Is Unduplicated) 712 1033.000000 37323.7500 36.1314
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 3 4.000000 200.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 19.500000 1462.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 26.500000 1470.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 18.500000 1387.5000 75.0000
Subtotal (Total Children Is Unduplicated) 30 81.500000 5320.2500 65.2791
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EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 11 13.000000 650.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 0.750000 37.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 9 9.250000 462.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 1.500000 75.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 11 9.000000 450.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 16 49.000000 2450.0000 50.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 4 3.750000 138.7500 37.0000
TRAV-TRAVS-Travel by mile 6 170.000000 75.6300 0.4449
Subtotal (Total Children Is Unduplicated) 41 262.250000 4639.3800 17.6907
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Total 1376.750000 47283.3800 34.3442
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Number of Children (Unduplicated) With at Least One Service 720
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Center 02
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 2504 1376.750000 47283.3800 0.0000
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Total 2504 1376.750000 47283.3800 0.0000