CMS/EIP Fiscal Report Center: 05
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
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 428 188.500000 6974.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 38 20.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1027 2480.500000 91778.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1041 2689.500000 98753.0000 36.7180
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EI Services,Class #03
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 0.250000 12.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 14.000000 140.0000 10.0000
Subtotal (Total Children Is Unduplicated) 4 14.250000 152.5000 10.7018
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Total 2703.750000 98905.5000 36.5809
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Number of Children (Unduplicated) With at Least One Service 1043
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Center 05
Flag Claims Units Chgs Paid
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R 11 9.000000 333.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2348 1541.000000 57017.0000 24341.3800
P 9 14.250000 152.5000 152.5000
D 1 0.500000 18.5000 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
2045 1116.000000 40533.5000 0.0000
Other 30 23.000000 851.0000 0.0000
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Total 4444 2703.750000 98905.5000 24493.8800